The following is the summary of  “Cigarette Smoking and Asthma” published in the November 2022 issue of Allergy and Clinical Immunology: In Practice by Thomson, et al.

On a global scale, almost half of the adult population with asthma is current or past smokers. The interaction between asthma and cigarette smoking results in the induction of a “asthma-smoking phenotype(s),” which has significant implications for the diagnosis, pathogenic mechanisms, and asthma therapy. Because individuals with asthma are excluded from most research studies and large clinical trials, there hasn’t been much progress in understanding the effects of smoking on those who already have asthma. 

In the review, researchers provided a summary of the adverse clinical outcomes that were associated with cigarette smoking in asthma, highlighted the challenges in diagnosing asthma among cigarette smokers with chronic respiratory symptoms, particularly in older individuals with a long-standing smoking history, and reviewed the pathogenic mechanisms involving smoking; and asthma-related airway inflammation, tissue remodeling, corticosteroid insensitivity, and low-grade systemic inflammation. Finally, investigators discuss the most important aspects of management, such as the significance of strategies for quitting smoking, the evidence supporting the efficacy of the recommendations made by the Global Initiative for Asthma regarding treatment for people who smoke cigarettes, and the role of traits that can be treated, such as type 2 eosinophilic airway inflammation. 

They offered a protocol clinicians can use to manage better current and former smokers who suffer from asthma. To offer an evidence base for treatment recommendations in the future, controlled and pragmatic studies in real-world populations should include cigarette smokers with asthma. These trials should take place in real-world populations.