Can Asthma Be Managed in Smokers?

Eligibility criteria for most randomized controlled trials looking at asthma eliminate an estimated 95% of patients with a current diagnosis, since they exclude, among others, patients with asthma who smoke. According to the Centers for Disease Control and Prevention, that group is approximately 21% of people who have asthma. Smokers who have asthma are known to respond poorly to mainstay steroid therapy but there is little more than observational data to support other pharmacologic interventions.The 8 slides above summarize what we know about what works in this difficult population. 

References:

1. Clatworthy J, Price D, Ryan D, et al. The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control. Prim Care Respir J. 2009;18:300-5. doi: 10.4104/pcrj.2009.00037.

2. Price D, Bjermer L, Popov TA, et al. Integrating evidence for managing asthma in patients who smoke. Allergy Asthma Immunol Res. 2014;6:114-120. doi: 10.4168/aair.2014.6.2.114. Epub 2014 Feb 17.

3. Tomlinson JE, McMahon AD, Chaudhuri R, et al. Efficacy of low and high dose inhaled corticosteroid in smokers versus non-smokers with mild asthma. Thorax. 2005;60:282-7.

4. Price D, Popov TA, Bjermer L, Lu S, et al. Effect of montelukast for treatment of asthma in cigarette smokers. J Allergy Clin Immunol. 2013;131:763-771. doi: 10.1016/j.jaci.2012.12.673. Epub 2013 Feb 4. .

5. Brusselle G, Peché R, Van den Brande P, et al. Real-life effectiveness of extrafine beclomethasone dipropionate/formoterol in adults with persistent asthma according to smoking status. Respir Med. 2012;106:811-819. doi: 10.1016/j.rmed.2012.01.010. Epub 2012 Feb 20.