Influence cigarette smoking on inhaled corticosteroid treatment in mild asthma

Chalmers, G. W.; Macleod, K. J.; Little, S. A.; Thomson, L. J.; McSharry, C. P.; Thomson, N. C.
March 2002
Thorax;Mar2002, Vol. 57 Issue 3, p226
Academic Journal
Background: Although inhaled corticosteroids have an established role in the treatment of asthma, studies have tended to concentrate on non-smokers and little is known about the possible effect of cigarette smoking on the efficacy of treatment with inhaled steroids in asthma. A study was undertaken to investigate the effect of active cigarette smoking on responses to treatment with inhaled corticosteroids in patients with mild asthma. Methods: The effect of treatment with inhaled fluticasone propionate (1000 μg daily) or placebo for 3 weeks was studied in a double blind, prospective, randomised, placebo controlled study of 38 steroid naïve adult asthmatic patients (21 non-smokers). Efficacy was assessed using morning and evening peak expiratory flow (PEE) readings, spirometric parameters, bronchial hyperreactivity, and sputum eosinophil counts. Comparison was made between responses to treatment in non-smoking and smoking asthmatic patients. Results: There was a significantly greater increase in mean morning PEE in non-smokers than in smokers following inhaled fluticasone (27 l/mm v -5 l/mm). Non-smokers had a statistically significant increase in mean morning PEF (27 l/mm), mean forced expiratory volume in l second (0.17 l), and geometric mean PC20 (2.6 doubling doses), and a significant decrease in the proportion of sputum eosinophils(-l .75%) after fluticasone compared with placebo. No significant changes were observed in the smoking asthmatic patients for any of these parameters. Conclusions: Active cigarette smoking impairs the efficacy of short term inhaled corticosteroid treatment in mild asthma. This finding has important implications for the management of patients with mild asthma who smoke.


Related Articles

  • Impact of Smoking on Asthma Therapy: A Critical Review of Clinical Evidence. Livingston, Eric; Thomson, Neil C.; Chalmers, George W. // Drugs;2005, Vol. 65 Issue 11, p1521 

    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...

  • Asthma or COPD? Pinkowish, Mary Desmond // Patient Care;Jun2003, Vol. 37 Issue 6, p16 

    Proposes an approach how to deal with a patient with a history of asthma who also exhibits persistent coughing and wheezing. Smoking habit of the patient; Possible explanations why the patient is still exhibiting airflow obstruction after a 7-day course of corticosteroids; Deficiency that...

  • Inhaled corticosteroids reduce fatal asthma.  // Patient Care;3/30/1993, Vol. 27 Issue 6, p158 

    Discusses research being done on the risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use. Reference to a study by P. Ernst et al, published in a 1992 issue of the "Journal of American Medical Association"; Study participants; Number of asthma fatalities identified by...

  • Lung function decline in asthma: association with inhaled corticosteroids, smoking and sex. Dijkstra, A.; Vonk, J. M.; Jongepier, H.; Koppelman, G. H.; Schouten, J. P.; Ten Hacken, N. H. T.; Timens, W.; Postma, D. S. // Thorax;Feb2006, Vol. 61 Issue 2, p105 

    Background: Inhaled corticosteroids (ICS) provide short term benefits in asthma but the long term effects are still unknown. Methods: 281 patients diagnosed with moderate to severe asthma in 1963-75 were re-examined in 1991-9. Information was collected on forced expiratory volume in 1 second...

  • Smoking has a negative impact on asthma and alters the response to some asthma therapies. Adis International Limited // Drugs & Therapy Perspectives;Feb2006, Vol. 22 Issue 2, p23 

    Although many asthmatics are regular smokers, there are limited data on the response of smokers to asthma therapy. The symptoms of asthma are worse in smokers than in nonsmokers, with an increase in the frequency and severity of attacks. Corticosteroids are the most effective medication for the...

  • Corticosteroids not a cure for asthma in toddlers. Chambers, Christopher V.; Russell, John J. // Patient Care;Jul2006, Vol. 40 Issue 7, p59 

    Presents an abstract of the study "Long-Term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma," by T. W. Guilbert and colleagues, which appeared in the 2006 issue of the "New England Journal of Medicine."

  • Asthma: clinical assessment.  // Thorax;Dec2004 Supplement, Vol. 59, p50 

    The article presents some papers related to clinical assessment of asthma. There is currently great interest in developing non-invasive measures of airway inflammation in asthma. Proposed markers of airway inflammation and or oxidative stress in asthma include the exhaled gases, nitric oxide...

  • Biopharmaceutical Therapeutics for Asthma Remodeling. Das, A. M.; Griswold, D. E.; Torphy, T. J.; Li, L. // Current Pharmaceutical Design;Sep2006, Vol. 12 Issue 25, p3233 

    Current asthma therapy is aimed at controlling disease symptoms. A subset of asthma patients remains symptomatic despite optimal therapy indicating that an unmet medical need exists for these patients. Innovative therapeutics are needed to treat the unmet need in asthma and biopharmaceutical...

  • Magnesium and Outcomes in Children with Acute Asthma. Sadovsky, Richard // American Family Physician;6/15/2001, Vol. 63 Issue 12, p2441 

    Presents information on a study by R.J. Scarfone and others that studied the early administration of magnesium to moderately to severely ill children with asthma in a randomized, double-blind, placebo-controlled clinical trial. Description of the study and its results; Conclusion that among a...


Read the Article


Sign out of this library

Other Topics