Efficacy of low and high dose inhaled corticosteroid in smokers versus non-smokers with mild asthma

J E M Tomlinson, A D McMahon, R Chaudhuri, J M Thompson, S F Wood, N C Thomson, J E M Tomlinson, A D McMahon, R Chaudhuri, J M Thompson, S F Wood, N C Thomson

Abstract

Background: Cigarette smokers with asthma are insensitive to short term inhaled corticosteroid therapy, but efficacy when given for a longer duration at different doses is unknown.

Methods: Ninety five individuals with mild asthma were recruited to a multicentre, randomised, double blind, parallel group study comparing inhaled beclomethasone in doses of 400 microg or 2000 microg daily for 12 weeks in smokers and non-smokers. The primary end point was the change in morning peak expiratory flow (PEF). Secondary end points included evening PEF, use of reliever inhaler, number of asthma exacerbations, spirometric parameters, and asthma control score.

Results: After 12 weeks of inhaled beclomethasone there was a considerable difference between the morning PEF measurements of smokers and non-smokers with asthma (-18 (95% CI -35 to -1), adjusted p = 0.035). Among those receiving 400 microg daily there was a difference between the mean (95% CI) morning PEF (l/min) in smokers and non-smokers (-25 (95% CI -45 to -4), adjusted p = 0.019) and in the number of asthma exacerbations (6 v 1 in smokers and non-smokers, respectively, p = 0.007). These differences were reduced between smokers and non-smokers receiving 2000 microg inhaled beclomethasone daily.

Conclusions: Compared with non-smokers, smokers with mild persistent asthma are insensitive to the therapeutic effect of low dose inhaled corticosteroid treatment administered for a 12 week period. The disparity of the response between smokers and non-smokers appears to be reduced with high dose inhaled corticosteroid. These findings have important implications for the management of individuals with mild asthma who smoke.

References

    1. Allergy. 2001 Sep;56(9):813-24
    1. Respir Med. 2001 May;95(5):319-23
    1. Thorax. 2002 Aug;57(8):683-6
    1. Int J Tuberc Lung Dis. 2003 Jan;7(1):84-92
    1. Chest. 2003 May;123(5):1472-9
    1. Am J Respir Crit Care Med. 2003 Dec 1;168(11):1308-11
    1. Eur Respir J. 2004 Jun;23(6):932-46
    1. Thorax. 1984 Nov;39(11):828-32
    1. Am Rev Respir Dis. 1992 Jul;146(1):76-81
    1. Am J Respir Crit Care Med. 1995 May;151(5):1320-5
    1. Am J Respir Crit Care Med. 1996 May;153(5):1519-29
    1. N Engl J Med. 1998 Oct 22;339(17):1194-200
    1. BMJ. 1999 Feb 6;318(7180):380-4
    1. J Asthma. 1999 May;36(3):257-64
    1. Thorax. 1999 Apr;54(4):296-300
    1. Eur Respir J. 2004 Nov;24(5):822-33
    1. JAMA. 2004 Dec 22;292(24):2977-83
    1. Eur Respir J. 1999 Oct;14(4):902-7
    1. Thorax. 2002 Mar;57(3):226-30

Source: PubMed

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