Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma

Stephen C. Lazarus, Vernon M. Chinchilli, Nancy J. Rollings, Homer A. Boushey, Reuben Cherniack, Timothy J. Craig, Aaron Deykin, Emily DiMango, James E. Fish, Jean G. Ford, Elliot Israel, James Kiley, Monica Kraft, Robert F. Lemanske, Frank T. Leone, Richard J. Martin, Gene R. Pesola, Stephen P. Peters, Christine A. Sorkness, Stanley J. Szefler & 2 others Michael E. Wechsler, John V. Fahy

Research output: Contribution to journalArticle

Abstract

Rationale: One-quarter to one-third of individuals with asthma smoke, which may affect response to therapy and contribute to poor asthma control. Objectives: To determine if the response to an inhaled corticosteroid or a leukotriene receptor antagonist is attenuated in individuals with asthma who smoke. Methods: In a multicenter, placebo-controlled, double-blind, doubledummy, crossover trial, 44 nonsmokers and 39 light smokers with mild asthma were assigned randomly to treatment twice daily with inhaled beclomethasone and once daily with oral montelukast. Measurements and Main Results: Primary outcome was change in prebronchodilator FEV1 in smokers versus nonsmokers. Secondary outcomes included peak flow, PC20 methacholine, symptoms, quality of life, and markers of airway inflammation. Despite similar FEV1, bronchodilator response, and sensitivity to methacholine at baseline, subjects with asthma who smoked had significantly more symptoms, worse quality of life, and lower daily peak flow than nonsmokers. Adherence to therapy did not differ significantly between smokers and nonsmokers, or between treatment arms. Beclomethasone significantly reduced sputum eosinophils and eosinophil cationic protein (ECP) in both smokers and nonsmokers, but increased FEV1 (170 ml, p = 0.0003) only in nonsmokers. Montelukast significantly increased A.M. peak flow in smokers (12.6 L/min, p = 0.002), but not in nonsmokers. Conclusions: In subjects with mild asthma who smoke, the response to inhaled corticosteroids is attenuated, suggesting that adjustments to standard therapy may be required to attain asthma control. The greater improvement seen in some outcomes in smokers treated with montelukast suggests that leukotrienes may be important in this setting. Larger prospective studies are required to determine whether leukotriene modifiers can be recommended for managing asthma in patients who smoke.

Original languageEnglish (US)
Pages (from-to)783-790
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume175
Issue number8
DOIs
StatePublished - Apr 14 2007
Externally publishedYes

Fingerprint

Leukotriene Antagonists
Steroid Receptors
montelukast
Asthma
Smoking
Smoke
Beclomethasone
Methacholine Chloride
Leukotrienes
Adrenal Cortex Hormones
Quality of Life
Eosinophil Cationic Protein
Therapeutics
Bronchodilator Agents
Sputum
Eosinophils
Cross-Over Studies
Placebos
Prospective Studies
Inflammation

Keywords

  • Antiasthmatic agents
  • Corticosteroids
  • Leukotrienes
  • Smoking adverse effects

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Lazarus, S. C., Chinchilli, V. M., Rollings, N. J., Boushey, H. A., Cherniack, R., Craig, T. J., ... Fahy, J. V. (2007). Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma. American Journal of Respiratory and Critical Care Medicine, 175(8), 783-790. https://doi.org/10.1164/rccm.200511-1746OC

Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma. / Lazarus, Stephen C.; Chinchilli, Vernon M.; Rollings, Nancy J.; Boushey, Homer A.; Cherniack, Reuben; Craig, Timothy J.; Deykin, Aaron; DiMango, Emily; Fish, James E.; Ford, Jean G.; Israel, Elliot; Kiley, James; Kraft, Monica; Lemanske, Robert F.; Leone, Frank T.; Martin, Richard J.; Pesola, Gene R.; Peters, Stephen P.; Sorkness, Christine A.; Szefler, Stanley J.; Wechsler, Michael E.; Fahy, John V.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 175, No. 8, 14.04.2007, p. 783-790.

Research output: Contribution to journalArticle

Lazarus, SC, Chinchilli, VM, Rollings, NJ, Boushey, HA, Cherniack, R, Craig, TJ, Deykin, A, DiMango, E, Fish, JE, Ford, JG, Israel, E, Kiley, J, Kraft, M, Lemanske, RF, Leone, FT, Martin, RJ, Pesola, GR, Peters, SP, Sorkness, CA, Szefler, SJ, Wechsler, ME & Fahy, JV 2007, 'Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma', American Journal of Respiratory and Critical Care Medicine, vol. 175, no. 8, pp. 783-790. https://doi.org/10.1164/rccm.200511-1746OC
Lazarus, Stephen C. ; Chinchilli, Vernon M. ; Rollings, Nancy J. ; Boushey, Homer A. ; Cherniack, Reuben ; Craig, Timothy J. ; Deykin, Aaron ; DiMango, Emily ; Fish, James E. ; Ford, Jean G. ; Israel, Elliot ; Kiley, James ; Kraft, Monica ; Lemanske, Robert F. ; Leone, Frank T. ; Martin, Richard J. ; Pesola, Gene R. ; Peters, Stephen P. ; Sorkness, Christine A. ; Szefler, Stanley J. ; Wechsler, Michael E. ; Fahy, John V. / Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma. In: American Journal of Respiratory and Critical Care Medicine. 2007 ; Vol. 175, No. 8. pp. 783-790.
@article{895ec3d47aa74e90be76a7a89ecebbdb,
title = "Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma",
abstract = "Rationale: One-quarter to one-third of individuals with asthma smoke, which may affect response to therapy and contribute to poor asthma control. Objectives: To determine if the response to an inhaled corticosteroid or a leukotriene receptor antagonist is attenuated in individuals with asthma who smoke. Methods: In a multicenter, placebo-controlled, double-blind, doubledummy, crossover trial, 44 nonsmokers and 39 light smokers with mild asthma were assigned randomly to treatment twice daily with inhaled beclomethasone and once daily with oral montelukast. Measurements and Main Results: Primary outcome was change in prebronchodilator FEV1 in smokers versus nonsmokers. Secondary outcomes included peak flow, PC20 methacholine, symptoms, quality of life, and markers of airway inflammation. Despite similar FEV1, bronchodilator response, and sensitivity to methacholine at baseline, subjects with asthma who smoked had significantly more symptoms, worse quality of life, and lower daily peak flow than nonsmokers. Adherence to therapy did not differ significantly between smokers and nonsmokers, or between treatment arms. Beclomethasone significantly reduced sputum eosinophils and eosinophil cationic protein (ECP) in both smokers and nonsmokers, but increased FEV1 (170 ml, p = 0.0003) only in nonsmokers. Montelukast significantly increased A.M. peak flow in smokers (12.6 L/min, p = 0.002), but not in nonsmokers. Conclusions: In subjects with mild asthma who smoke, the response to inhaled corticosteroids is attenuated, suggesting that adjustments to standard therapy may be required to attain asthma control. The greater improvement seen in some outcomes in smokers treated with montelukast suggests that leukotrienes may be important in this setting. Larger prospective studies are required to determine whether leukotriene modifiers can be recommended for managing asthma in patients who smoke.",
keywords = "Antiasthmatic agents, Corticosteroids, Leukotrienes, Smoking adverse effects",
author = "Lazarus, {Stephen C.} and Chinchilli, {Vernon M.} and Rollings, {Nancy J.} and Boushey, {Homer A.} and Reuben Cherniack and Craig, {Timothy J.} and Aaron Deykin and Emily DiMango and Fish, {James E.} and Ford, {Jean G.} and Elliot Israel and James Kiley and Monica Kraft and Lemanske, {Robert F.} and Leone, {Frank T.} and Martin, {Richard J.} and Pesola, {Gene R.} and Peters, {Stephen P.} and Sorkness, {Christine A.} and Szefler, {Stanley J.} and Wechsler, {Michael E.} and Fahy, {John V.}",
year = "2007",
month = "4",
day = "14",
doi = "10.1164/rccm.200511-1746OC",
language = "English (US)",
volume = "175",
pages = "783--790",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "American Thoracic Society",
number = "8",

}

TY - JOUR

T1 - Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma

AU - Lazarus, Stephen C.

AU - Chinchilli, Vernon M.

AU - Rollings, Nancy J.

AU - Boushey, Homer A.

AU - Cherniack, Reuben

AU - Craig, Timothy J.

AU - Deykin, Aaron

AU - DiMango, Emily

AU - Fish, James E.

AU - Ford, Jean G.

AU - Israel, Elliot

AU - Kiley, James

AU - Kraft, Monica

AU - Lemanske, Robert F.

AU - Leone, Frank T.

AU - Martin, Richard J.

AU - Pesola, Gene R.

AU - Peters, Stephen P.

AU - Sorkness, Christine A.

AU - Szefler, Stanley J.

AU - Wechsler, Michael E.

AU - Fahy, John V.

PY - 2007/4/14

Y1 - 2007/4/14

N2 - Rationale: One-quarter to one-third of individuals with asthma smoke, which may affect response to therapy and contribute to poor asthma control. Objectives: To determine if the response to an inhaled corticosteroid or a leukotriene receptor antagonist is attenuated in individuals with asthma who smoke. Methods: In a multicenter, placebo-controlled, double-blind, doubledummy, crossover trial, 44 nonsmokers and 39 light smokers with mild asthma were assigned randomly to treatment twice daily with inhaled beclomethasone and once daily with oral montelukast. Measurements and Main Results: Primary outcome was change in prebronchodilator FEV1 in smokers versus nonsmokers. Secondary outcomes included peak flow, PC20 methacholine, symptoms, quality of life, and markers of airway inflammation. Despite similar FEV1, bronchodilator response, and sensitivity to methacholine at baseline, subjects with asthma who smoked had significantly more symptoms, worse quality of life, and lower daily peak flow than nonsmokers. Adherence to therapy did not differ significantly between smokers and nonsmokers, or between treatment arms. Beclomethasone significantly reduced sputum eosinophils and eosinophil cationic protein (ECP) in both smokers and nonsmokers, but increased FEV1 (170 ml, p = 0.0003) only in nonsmokers. Montelukast significantly increased A.M. peak flow in smokers (12.6 L/min, p = 0.002), but not in nonsmokers. Conclusions: In subjects with mild asthma who smoke, the response to inhaled corticosteroids is attenuated, suggesting that adjustments to standard therapy may be required to attain asthma control. The greater improvement seen in some outcomes in smokers treated with montelukast suggests that leukotrienes may be important in this setting. Larger prospective studies are required to determine whether leukotriene modifiers can be recommended for managing asthma in patients who smoke.

AB - Rationale: One-quarter to one-third of individuals with asthma smoke, which may affect response to therapy and contribute to poor asthma control. Objectives: To determine if the response to an inhaled corticosteroid or a leukotriene receptor antagonist is attenuated in individuals with asthma who smoke. Methods: In a multicenter, placebo-controlled, double-blind, doubledummy, crossover trial, 44 nonsmokers and 39 light smokers with mild asthma were assigned randomly to treatment twice daily with inhaled beclomethasone and once daily with oral montelukast. Measurements and Main Results: Primary outcome was change in prebronchodilator FEV1 in smokers versus nonsmokers. Secondary outcomes included peak flow, PC20 methacholine, symptoms, quality of life, and markers of airway inflammation. Despite similar FEV1, bronchodilator response, and sensitivity to methacholine at baseline, subjects with asthma who smoked had significantly more symptoms, worse quality of life, and lower daily peak flow than nonsmokers. Adherence to therapy did not differ significantly between smokers and nonsmokers, or between treatment arms. Beclomethasone significantly reduced sputum eosinophils and eosinophil cationic protein (ECP) in both smokers and nonsmokers, but increased FEV1 (170 ml, p = 0.0003) only in nonsmokers. Montelukast significantly increased A.M. peak flow in smokers (12.6 L/min, p = 0.002), but not in nonsmokers. Conclusions: In subjects with mild asthma who smoke, the response to inhaled corticosteroids is attenuated, suggesting that adjustments to standard therapy may be required to attain asthma control. The greater improvement seen in some outcomes in smokers treated with montelukast suggests that leukotrienes may be important in this setting. Larger prospective studies are required to determine whether leukotriene modifiers can be recommended for managing asthma in patients who smoke.

KW - Antiasthmatic agents

KW - Corticosteroids

KW - Leukotrienes

KW - Smoking adverse effects

UR - http://www.scopus.com/inward/record.url?scp=34247344095&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247344095&partnerID=8YFLogxK

U2 - 10.1164/rccm.200511-1746OC

DO - 10.1164/rccm.200511-1746OC

M3 - Article

VL - 175

SP - 783

EP - 790

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 8

ER -