Addressing Smoking Cessation in Asthma

An estimated 20 percent of individuals with asthma smoke cigarettes, new findings suggest. And compared with non-smokers with asthma, smokers with asthma have elevated morbidity and mortality, worse asthma control, more frequent exacerbations and severe symptoms, and a greater incidence of life-threatening attacks, Pulmonology Advisor reported.

Additionally, individuals who smoke are more likely to experience a more “rapid decline in lung function and permanent chronic airflow obstruction,” with as much as threefold risk of airflow obstruction in patients with non-atopic asthma, in particular. New adult-onset asthma was 20 percent to 40 percent higher in active and passive smokers compared with non-smokers with asthma.

Asthmatic smokers and former smokers, though, are typically excluded from trials investigating asthma therapies so there is usually a lack of clarity regarding optimal treatment options for these patients.

Smoking Cessation in Patients with Asthma

Smoking cessation plans in patients with asthma have been shown to reduce asthma symptoms, and lead to improved lung function and quality of life, as well as reduced use of rescue medications, improved airway responsiveness and decreased hyperactivity.

“A plausible explanation for the improvement in various outcomes is that there is a gradual and progressive reduction of pro-inflammatory effects in the airways related to the decreased inhalation of cigarette smoke,” researchers offered.

The study also suggested that clinicians inform their patients that “numerous cessation attempts may be necessary” before they are able to quit altogether, but that clinicians should be familiar with basic behavioral techniques to help patients navigate strategies to handle smoking triggers and withdrawal symptoms. Smoking cessation agents, buproprion and varenicline, have been shown to increase cessation success rates, which patients may be interested in pursuing as quit options.

For example, a separate study examined the use of varenicline in smokers with asthma and found increased rates of cessation and improved airway hyper-responsiveness compared with placebo.

Treating Asthmatic Smokers

While corticosteroids should generally be included in the treatment strategy for most patients with asthma, study results indicate that up to one-third of asthmatic smokers do not respond to these drugs.

“A possible mechanism for the corticosteroids insensitivity or resistance may be the increased airway mucosal permeability in smokers, which could lead to increased clearance of inhaled corticosteroids from the airways,” the review authors pointed out in a statement.

Other approaches may be more effective, however.

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