ASTHMA

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

J E M Tomlinson¹, A D McMahon², R Chaudhuri³, J M Thompson¹, S F Wood¹, N C Thomson³

¹ Department of General Practice, University of Glasgow, Glasgow, UK
² Department of Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
³ Department of Respiratory Medicine, University of Glasgow, Glasgow, UK

Correspondence to:
Correspondence to:
Professor N C Thomson
Department of Respiratory Medicine, Division of Immunology, Infection and Inflammation, Western Infirmary, Glasgow G11 6NT UK; n.c.thomson{at}clinmed.gla.ac.uk

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 µg or 2000 µg 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 µg 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 µg 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.

Abbreviations: FEV₁, forced expiratory volume in 1 second; PEF, peak expiratory flow

Keywords: asthma; corticosteroid resistance; smoking; corticosteroid dosage

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Smoke sensitivity versus corticosteroid insensitivity in asthma

Daniel K C Lee

Thorax Online, 17 May 2005 [Full text]