Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma

Chalmers, George; MacLeod, Kirsten J; Little, Sally A.; Thomson, L.; McSharry, Charles; Thomson, Neil C.

doi:10.1136/thorax.57.3.226

Cited by 497 publications

(376 citation statements)

References 29 publications

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“…It can be demonstrated in peripheral blood mononuclear cells and alveolar macrophages, and in resident cells such as airway smooth muscle cells from patients with severe asthma [166][167][168][169], but the relationship of these in vitro studies to in vivo responses is not well understood. Corticosteroid insensitivity has been associated with different comorbid conditions such as obesity [170], smoking [171], low vitamin D levels [172,173], and non-eosinophilic (low-Th2 inflammation) mainly in adults [174]. In children, less is known about the role of these mechanisms.…”

Section: Using Established Asthma Medications Corticosteroid Insensitmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

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Section: Using Established Asthma Medications Corticosteroid Insensitmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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“…The therapeutic response of these patients to ICS is attenuated [120,121], and whether they should be treated with higher doses of ICS, or with combination therapy of ICS and LABA or LTRA is unclear.…”

Section: Mild Persistent Asthmamentioning

confidence: 99%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

123

106

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International audienceInhaled corticosteroid (ICS) therapy in combination with long-acting β-adrenergic agonists represents the most important treatment for chronic airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). ICS therapy forms the basis for treatment of asthma of all severities, improving asthma control, lung function and preventing exacerbations of disease. Use of ICS has also been established in the treatment of COPD, particularly symptomatic patients, who experience useful gains in quality of life, likely from an improvement in symptoms such as breathlessness and in reduction in exacerbations, and an attenuation of the yearly rate of deterioration in lung function. The addition of long-acting β-agonist (LABA) therapy with ICS increases the efficacy of ICS effects in moderate-to-severe asthma. Thus, a 800 μg daily dose of the ICS budesonide reduced severe exacerbation rates by 49% compared to a low dose of 200 μg daily, and addition of the LABA formoterol to budesonide (800 μg) led to a 63% reduction. In COPD, the effects of ICS are less prominent but there are beneficial effects on the decline in FEV and the rate of exacerbations. A reduction in the rate of decline in FEV of 16 ml/year with a 25% reduction in exacerbation rate has been reported with the salmeterol and fluticasone combination. A non-significant 17.5% reduction in all-cause mortality rate with ICS and LABA is reported. Chronic inflammation is a feature of both asthma and COPD, although there are site and characteristic differences. ICS targets this inflammation although this effect of ICS is less effective in patients with severe asthma and with COPD; however, addition of LABA may potentiate the anti-inflammatory effects of ICS. An important consideration is the presence of corticosteroid insensitivity in these patients. Currently available ICS have variably potent binding activities to specific glucocorticoid receptors, leading to inhibition of gene expression by either binding to DNA and inducing anti-inflammatory genes or by repressing the induction of pro-inflammatory mediators. Local side effects of ICS include oral candidiasis, hoarseness and dysphonia, while systemic side effects, such as easy bruising and reduction in growth velocity or bone mineral densitometry, are usually restricted to doses above maximally recommended doses. Use of LABA alone in patients with asthma increases the risk of asthma-related events including deaths, but this is less observed with the combination of ICS and LABA. Therefore, use of LABA alone is not recommended for asthma therapy. Future progress in ICS development will be characterised by the introduction of ICS with greater efficacy with a limited side-effect profile, and by longer-acting ICS that can be used in combination with once-daily LABAs. Other agents that could improve the efficacy of corticosteroids or reverse corticosteroid insensitivity may be added to ICS. ICS in combination with LABAs will continue to remain the main focus of treatment of airways diseases

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“…(11) Within the last 60 years, the noxious effects of exposure to cigarette smoke have been progres- changes in the values of these parameters. (18) Another study, in which inhaled budesonide was used for 9 months, also showed that the asthma patients who smoked were resistant to corticosteroids. (19) When prednisolone (40 mg/day) was used, the results were similar.…”

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confidence: 99%

Prevalência de tabagismo ativo e passivo em uma população de asmáticos

et al. 2009

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Smoking causes an intense inflammatory reaction in the airways and is associated with worse clinical outcomes in patients with asthma. The objective of this study was to determine the prevalence of active and passive smoking in a population of patients with asthma. The sample of asthma patients (n = 100) consisted of 47 nonsmokers, 33 former smokers, 17 passive smokers and 3 active smokers. Most had moderate or severe asthma. Mean exhaled CO was 9.34 ppb in smokers, 4.19 ppb in passive smokers, 3.98 ppb in nonsmokers and 3.98 ppb in former smokers. We conclude that the prevalence of exposure to tobacco smoke is high among asthma patients.Keywords: Smoking; Asthma; Prevalence. ResumoO tabagismo causa intensa reação inflamatória nas vias aéreas e, em asmáticos, está associado com piores desfechos clínicos. O objetivo desse estudo foi determinar a prevalência de tabagismo ativo e passivo em uma população de asmáticos. A amostra de pacientes com asma (n = 100) consistiu em 47 não-fumantes, 33 ex-fumantes e 3 fumantes ativos. A maioria dos pacientes tinha asma moderada ou grave. A média de CO exalado foi de 9,34 ppb nos tabagistas atuais, 4,19 ppb nos fumantes passivos e 3,98 ppb tanto nos não-fumantes quanto nos ex-fumantes. Concluímos que a prevalência da exposição à fumaça do tabaco é alta entre asmáticos.

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Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma

Cited by 497 publications

References 29 publications

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Prevalência de tabagismo ativo e passivo em uma população de asmáticos

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