Cigarette smoking and asthma

Thomson, N. C., Polosa, R. and Sin, D. D. (2022) Cigarette smoking and asthma. Journal of Allergy and Clinical Immunology: In Practice, 10(11), pp. 2783-2797. (doi: 10.1016/j.jaip.2022.04.034) (PMID:35533997)

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Globally, around half the adult asthma population are current or former cigarette smokers. Cigarette smoking and asthma interact to induce an ‘asthma-smoking phenotype(s)’, which has important implications for diagnosis, pathogenic mechanisms, and management. The lack of progress in understanding the effects of smoking on adults with asthma is due in part to their exclusion from most investigative studies and large clinical trials. In this review, we summarize the adverse clinical outcomes associated with cigarette smoking in asthma, highlight challenges in diagnosing asthma among cigarette smokers with chronic respiratory symptoms, particularly in older individuals with a long-standing smoking history, and review pathogenic mechanisms involving smoking and asthma-related airway inflammation, tissue remodeling, corticosteroid insensitivity, and low-grade systemic inflammation. We discuss key components of management including the importance of smoking cessation strategies, evidence for the effectiveness of the Global Initiative for Asthma recommendations on treatment in cigarette smokers, and the role of treatable traits such as type 2 eosinophilic airway inflammation. Lastly, we provide an algorithm to aid clinicians to manage current and former smokers with asthma. In the future, controlled and pragmatic trials in real-world populations should include cigarette smokers with asthma to provide an evidence base for treatment recommendations.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Thomson, Professor Neil
Authors: Thomson, N. C., Polosa, R., and Sin, D. D.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity
Journal Name:Journal of Allergy and Clinical Immunology: In Practice
ISSN (Online):2213-2201
Published Online:06 May 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of Allergy and Clinical Immunology: In Practice 10(11): 2783-2797
Publisher Policy:Reproduced under a Creative Commons License

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