Cigarette smoking impairs the therapeutic response to oral corticosteroids in chronic asthma

Chaudhuri, R. , Livingston, E., McMahon, A. D., Thomson, L., Borland, W. and Thomson, N. C. (2003) Cigarette smoking impairs the therapeutic response to oral corticosteroids in chronic asthma. American Journal of Respiratory and Critical Care Medicine, 168(11), pp. 1308-1311. (doi: 10.1164/rccm.200304-503OC)

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Publisher's URL: http://dx.doi.org/10.1164/rccm.200304-503OC

Abstract

The study was designed to assess the effect of cigarette smoking on the therapeutic response to oral corticosteroids in chronic stable asthma. We performed a randomized, placebo-controlled, crossover study with prednisolone (40 mg daily) or placebo for 2 weeks in smokers with asthma, ex-smokers with asthma, and never-smokers with asthma. All subjects had reversibility in FEV<sub>1</sub> after nebulized albuterol of 15% or more and a mean postbronchodilator FEV<sub>1</sub>% predicted of more than 80%. Efficacy was assessed using FEV<sub>1</sub>, daily PEF, and an asthma control score. There was a significant improvement after oral prednisolone compared with placebo in FEV<sub>1</sub>, ml (mean difference, 237; 95% confidence intervals, 43, 231; p = 0.019), morning PEF L/m (mean difference, 36.8; 95% confidence intervals (CI), 11, 62; p = 0.006), and asthma control score (mean difference, −0.72; 95% CI, −1.2, −0.3; p = 0.004) in never-smokers with asthma but no change in smokers with asthma (mean differences of 47, 6.5, and −0.05 with p values of 0.605, 0.47, and 0.865, respectively). Ex-smokers with asthma had a significant improvement in morning and night PEF (mean difference, 29.1; CI, 2.3, 56; p = 0.04 and 52.4; CI, 26, 79; p = 0.003, respectively), but not in FEV<sub>1</sub> or asthma control score. We conclude that active smoking impairs the efficacy of short-term oral corticosteroid treatment in chronic asthma.<p></p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMahon, Dr Alex and Thomson, Professor Neil and Chaudhuri, Dr Rekha
Authors: Chaudhuri, R., Livingston, E., McMahon, A. D., Thomson, L., Borland, W., and Thomson, N. C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:American Journal of Respiratory and Critical Care Medicine
Publisher:American Thoracic Society
ISSN:1073-449X
ISSN (Online):1535-4970

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