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Impact of Smoking on Asthma Therapy

A Critical Review of Clinical Evidence

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Abstract

Airway inflammation is central to the pathophysiology of asthma, with treatment directed towards modification of this inflammation and its consequences. The relationship between cigarette smoking and airway inflammation is also well described, but relatively little data are available on the potential influence of smoking on asthmatic airway inflammation and its treatment. While cigarette smoking is common in people with asthma, with prevalence rates similar to the general population, studies in asthma have tended to concentrate on individuals who have never smoked. However, there is recent evidence that smoking may confer a degree of corticosteroid resistance in asthma, and this review examines the relationship between asthma and cigarette smoking, with particular reference to the impact of smoking on the response to treatment of asthma. Smoking has a number of known influences on drug activity and metabolism, but the mechanism underlying corticosteroid resistance in asthmatic smokers is not yet clear, although there are differences in the nature of the airway inflammation in individuals with asthma who smoke compared with nonsmoking asthmatic patients. Encouragingly, there is some evidence that smoking cessation may at least partially restore corticosteroid responsiveness in asthmatic ex-smokers. Smoking cessation measures must be given a high priority in individuals with asthma who smoke.

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Acknowledgements

We would like to thank NHS Education for Scotland, the Chief Scientist’s Office for Scotland, Chest Heart & Stroke Scotland and the National Asthma Campaign for their support of the work carried out in this area by the authors.

Conflicts of interest: Eric Livingston has been reimbursed by AstraZeneca (AZ) and GlaxoSmithKline (GSK), the manufacturers of budesonide, and beclomethasone and fluticasone, respectively, for attending conferences.

George W. Chalmers has been reimbursed by GSK, the manufacturers of fluticasone for attending conferences.

Neil C. Thomson has been reimbursed by AZ, GSK and Schering Plough, the manufacturers of budesonide, beclomethasone and fluticasone, and mometasone, respectively, for attending several conferences and has acted as a consultant to GSK and Altana. His department has received research funds for clinical trials from AZ, GSK, Novartis and Merck.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Division of Immunology, Infection and Inflammation, University of Glasgow, Glasgow, UK

    Eric Livingston & Neil C. Thomson

  2. Department of Respiratory Medicine, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK

    George W. Chalmers

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  1. Eric Livingston
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  2. Neil C. Thomson
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  3. George W. Chalmers
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Correspondence to George W. Chalmers.

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Livingston, E., Thomson, N.C. & Chalmers, G.W. Impact of Smoking on Asthma Therapy. Drugs 65, 1521–1536 (2005). https://doi.org/10.2165/00003495-200565110-00005

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