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Integrating evidence for managing asthma in patients who smoke.

Price, David; Bjermer, Leif LU ; Popov, Todor A and Chisholm, Alison (2014) In Allergy Asthma & Immunology Research 6(2). p.114-120
Abstract
Cigarette smoking among asthma patients is associated with worsening symptoms and accelerated decline in lung function. Smoking asthma is also characterized by increased levels of neutrophils and macrophages, and greater small airway remodeling, resulting in increased airflow obstruction and impaired response to corticosteroid therapy. As a result, smokers are typically excluded from asthma randomized controlled trials (RCTs). The strict inclusion/exclusion criteria used by asthma RCTs limits the extent to which their findings can be extrapolated to the routine care asthma population and to reflect the likely effectiveness of therapies in subgroups of particular clinical interest, such as smoking asthmatics. The inclusion of smokers in... (More)
Cigarette smoking among asthma patients is associated with worsening symptoms and accelerated decline in lung function. Smoking asthma is also characterized by increased levels of neutrophils and macrophages, and greater small airway remodeling, resulting in increased airflow obstruction and impaired response to corticosteroid therapy. As a result, smokers are typically excluded from asthma randomized controlled trials (RCTs). The strict inclusion/exclusion criteria used by asthma RCTs limits the extent to which their findings can be extrapolated to the routine care asthma population and to reflect the likely effectiveness of therapies in subgroups of particular clinical interest, such as smoking asthmatics. The inclusion of smokers in observational asthma studies and pragmatic trials in asthma provides a way of assessing the relative effectiveness of different treatment options for the management of this interesting clinical subgroup. Exploratory studies of possible treatment options for smoking asthma suggest potential utility in: prescribing higher-dose ICS; targeting the small airways of the lungs with extra-fine particle ICS formulations; targeting leukotreines, and possibly also combinations of these options. However, further studies are required. With the paucity of RCT data available, complementary streams of evidence (those from RCTs, pragmatic trials and observational studies) need to be combined to help guide judicious prescribing decisions in smokers with asthma. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Allergy Asthma & Immunology Research
volume
6
issue
2
pages
114 - 120
publisher
KOREAN ACAD ASTHMA ALLERGY & CLINICAL IMMUNOLOGY
external identifiers
  • pmid:24587946
  • wos:000333066600003
  • scopus:84894442822
ISSN
2092-7363
DOI
10.4168/aair.2014.6.2.114
language
English
LU publication?
yes
id
41992429-719b-4ac6-86ca-f18ae8bcadec (old id 4384062)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24587946?dopt=Abstract
date added to LUP
2014-04-01 23:07:26
date last changed
2017-10-29 03:20:34
@article{41992429-719b-4ac6-86ca-f18ae8bcadec,
  abstract     = {Cigarette smoking among asthma patients is associated with worsening symptoms and accelerated decline in lung function. Smoking asthma is also characterized by increased levels of neutrophils and macrophages, and greater small airway remodeling, resulting in increased airflow obstruction and impaired response to corticosteroid therapy. As a result, smokers are typically excluded from asthma randomized controlled trials (RCTs). The strict inclusion/exclusion criteria used by asthma RCTs limits the extent to which their findings can be extrapolated to the routine care asthma population and to reflect the likely effectiveness of therapies in subgroups of particular clinical interest, such as smoking asthmatics. The inclusion of smokers in observational asthma studies and pragmatic trials in asthma provides a way of assessing the relative effectiveness of different treatment options for the management of this interesting clinical subgroup. Exploratory studies of possible treatment options for smoking asthma suggest potential utility in: prescribing higher-dose ICS; targeting the small airways of the lungs with extra-fine particle ICS formulations; targeting leukotreines, and possibly also combinations of these options. However, further studies are required. With the paucity of RCT data available, complementary streams of evidence (those from RCTs, pragmatic trials and observational studies) need to be combined to help guide judicious prescribing decisions in smokers with asthma.},
  author       = {Price, David and Bjermer, Leif and Popov, Todor A and Chisholm, Alison},
  issn         = {2092-7363},
  language     = {eng},
  number       = {2},
  pages        = {114--120},
  publisher    = {KOREAN ACAD ASTHMA ALLERGY & CLINICAL IMMUNOLOGY},
  series       = {Allergy Asthma & Immunology Research},
  title        = {Integrating evidence for managing asthma in patients who smoke.},
  url          = {http://dx.doi.org/10.4168/aair.2014.6.2.114},
  volume       = {6},
  year         = {2014},
}