Despite the evidence and logical fact that smoking and asthma are incompatible, many patients are smoke. The proportion of smokers among asthmatics is comparable to the proportion of smokers in the population. The proportion of smokers among asthmatics is comparable to the proportion of smokers in the population. Currently, the prevalence of tobacco use in the Russian Federation remains high at over 20%. In addition to active smoking, patients may be exposed to the negative effects of tobacco smoke through secondhand smoke. Smokers with asthma are more likely to have signs of poor disease control, and are more likely to seek exacerbation. However, a therapy strategy for them has not been worked out. For many randomized trials, patient smoking is the exclusion criterion, and therefore the effectiveness of a particular anti-asthma therapy in smokers is poorly understood. In addition, it is a known fact that smoking develops resistance to the main anti-asthma therapy, inhalation glucocorticosteroids. The article discusses the mechanism of exposure to tobacco smoke on lung tissue, the development of pathological processes under the influence of components of tobacco smoke and possible solutions to the problem. The mechanism of inflammatory and anti-inflammatory effects of various components of tobacco smoke. Particular attention is paid to the role of cysteinyl leukotrienes in the formation of inflammation in the lower respiratory tract in smoking patients with asthma and the possibility of treating these patients with leukotriene receptor antagonists. A review of studies conducted in patients with bronchial asthma and exposure to tobacco smoke in whom montelukast was used as therapy is presented. Provides information on the safety and side effects of the drug.