Can Asthma Be Managed in Smokers?

October 1, 2015
Veronica Hackethal, MD
Veronica Hackethal, MD

The CDC estimates that 21% of people with asthma smoke cigarettes. These patients tend to be resistant to common asthma treatment. What are the options?

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.