Caring for the smoking asthmatic patient
| Autor: | Pasquale Caponnetto, Mark F. Sands, Riccardo Polosa |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Nicotine
medicine.medical_specialty Evidence-based practice Passive smoking medicine.medical_treatment Immunology medicine.disease_cause Quality of life Internal medicine Humans Immunology and Allergy Medicine Respiratory system Asthma Bronchial Spasm business.industry Incidence (epidemiology) Smoking medicine.disease respiratory tract diseases Clinical trial Evidence-Based Practice Practice Guidelines as Topic Smoking cessation Smoking Cessation business |
| Zdroj: | Journal of Allergy and Clinical Immunology. 130:1221-1224 |
| ISSN: | 0091-6749 |
| DOI: | 10.1016/j.jaci.2012.04.015 |
| Popis: | The asthmatic patient who smokes can represent a distinct disease entity in which a combination of asthma and chronic obstructive pulmonary disease–like phenotypes are blended to a variable degree. Appreciation of a smoking asthma phenotype might have important clinical, prognostic, and therapeutic implications. The goal of this article is to discuss clinical pearls that will assist physicians in managing these challenging patients. Smoking is associated with a higher incidence of asthma and is strongly predictive of the development of new-onset asthma in allergic adults. Compared with nonsmoking asthmatic patients, smoking asthmatic patients are at risk of more severe symptoms and worse asthma-specific quality of life, with a huge effect on health care resources because of unscheduled doctor’s office visits and frequent hospital admissions. Moreover, cigarette smoking in asthmatic patients is associated with higher frequencies of exacerbations, increased numbers of life-threatening asthma attacks, and greater asthma mortality. Asthma severity is higher and asthma control is worse in asthmatic patients who smoke, with the strongest association with more severe disease being observed in those who smoked more than 20 pack years. Exposure of adults and children to passive smoking also increases their asthma risk and worsens their respiratory symptoms. In most studies smoking accelerates the decrease in lung function and increases the severity of airflow obstruction in asthmatic patients. It is worth noting that lung function changes can be reversed with smoking cessation. Smoking asthmatic patients appear to be less sensitive to the beneficial effects of inhaled corticosteroids (ICSs) compared with nonsmoking asthmatic patients.Although ICSdosagemight relieve unresponsiveness, loss of responsiveness to ICSs continues to be present in spite of the length of treatment, steroid molecule used, and type of formulation (inhaled vs oral). Few clinical trials have |
| Databáze: | OpenAIRE |
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