Smoking asthma phenotype: diagnostic and management challenges

Area of Science:

• Pulmonology
• Respiratory Medicine
• Clinical Medicine

Background:

• Prevalence of active smoking in adults with asthma mirrors the general population.
• Smoking in asthmatic patients is linked to poorer disease control, reduced corticosteroid effectiveness, faster lung function decline, and higher healthcare use.
• Asthma guidelines lack specific management strategies for smoking asthmatic individuals.

Purpose of the Study:

• To review current understanding of smoking's impact on asthma.
• To highlight the need for better diagnostic and management approaches for smoking asthmatics.
• To emphasize the urgency in understanding mechanisms and treatments for this patient group.

Main Methods:

• Literature review of studies on smoking and adult-onset asthma.
• Analysis of treatment regimens for smoking asthma.
• Evaluation of comorbidities associated with smoking and asthma.

Main Results:

• Strong evidence links active and passive smoking to adult-onset asthma.
• Asthma-COPD Overlap Syndrome (ACOS) is a key consideration for smoking asthmatics.
• Recommended treatments include higher-dose inhaled corticosteroids (ICS), extrafine particle ICS, antileukotrienes, and combination therapies.
• Smoking, not asthma itself, is primarily responsible for poor prognosis, including increased risks of lung cancer, cardiovascular diseases, and mortality.

Conclusions:

• Smoking asthma presents significant diagnostic and management challenges for clinicians.
• Further research is essential to thoroughly evaluate and address these challenges.