Chest
Volume 129, Issue 3, March 2006, Pages 661-668
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Original Research: SMOKING
Smoking and Asthma: Clinical and Radiologic Features, Lung Function, and Airway Inflammation

https://doi.org/10.1378/chest.129.3.661Get rights and content

Smoking may influence the type of airway inflammation observed in asthma and its response to therapy. More studies are needed on how smoking-induced changes in lung function/structure and airway inflammation may result in a change in clinical expression. We compared clinical, physiologic, radiologic, and airway inflammatory features of 22 smoking asthma patients (cigarette smoking history, 14.0 ± 7.6 pack-years [mean ± SD]) and 27 nonsmoking asthma patients. Mean age/duration of asthma of smoking and nonsmoking asthma patients were 31 years/14 years and 29 years/17 years, respectively. Quality of life, FEV1, bronchodilator response, perception of bronchoconstriction, and methacholine responsiveness were similar in the two groups. Compared to nonsmoking asthma patients, smokers had more respiratory symptoms, a lower mean forced expiratory flow at 25 to 75% of FVC, FEV1/FVC ratio, and lung diffusion capacity, and a higher functional residual capacity. Induced-sputum neutrophil and bronchial cell counts were higher and exhaled breath condensate pH was more acidic in smoking asthma patients. On high-resolution CT, airway and parenchymal abnormalities were more common in smoking asthma patients than in nonsmokers. In conclusion, compared with nonsmoking asthma patients, smoking asthma patients have features similar to what could be found in early stages of COPD.

Section snippets

Patients

Eighteen- to 45-year-old, corticosteroid-naïve asthma patients were consecutively enrolled from the asthma clinics of Laval Hospital (Quebec City, Canada) and Sacré-Coeur Hospital (Montreal, Canada). Nonsmokers had not smoked in the last year and had a < 2 pack-year history of cigarette smoking; current smokers smoked > 10 cigarettes per day with > 5 pack-years of smoking. Smoking status was evaluated by self-report of study subjects. Patients had a medical history of asthma according to the

Patient Characteristics

Forty-nine patients, 22 smokers and 27 nonsmokers, completed the study (Table 1). The two groups of patients were similar in regard to age and time since diagnosis (Table 1). They included 24 women (11 nonsmokers and 13 smokers) and 25 men (16 nonsmokers and 9 smokers) aged 20 to 44 years (mean, 30 ± 7 years). Smoking history, as expressed by the number of mean pack-years, was 14.0 ± 7.6 pack-years (range, 5 to 32 pack-years). Twenty-five nonsmokers (93%) and 18 smokers (82%) were atopic.

Asthma Control

From

Discussion

Our study provides both confirmatory and original data on the effect of smoking on asthmatic airways and on the relationships between clinical, physiologic, radiologic, and inflammatory features in this population. Compared to nonsmoking asthma patients, smokers had increased respiratory symptoms, lower mean expiratory flows and lung diffusion capacity, and increased lung hyperinflation and induced-sputum neutrophil and bronchial cell counts. Exhaled breath condensate pH was more acidic in

ACKNOWLEDGMENT:

We are grateful to Johanne Lepage for her help conducting this study, Serge Simard for his suggestions on statistical analysis, Philippe Prince for his help with induced-sputum analysis, and Michel Laviolette, Franċois Maltais, Yvon Cormier, and Lori Schubert for reviewing the manuscript.

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    Supported by an unrestricted Grant from AstraZeneca Canada.

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