RT Journal Article
SR Electronic
T1 Smoking and Asthma
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 313
OP 322
DO 10.3122/jabfm.2011.03.100180
VO 24
IS 3
A1 Megan Stapleton
A1 Amanda Howard-Thompson
A1 Christa George
A1 Robert M. Hoover
A1 Timothy H. Self
YR 2011
UL http://www.jabfm.org/content/24/3/313.abstract
AB Background: The purpose of this review is to describe the current understanding of the prevalence and adverse effects of cigarette smoking and secondhand smoke (SHS) in asthmatics in terms of patient outcomes and response to inhaled corticosteroids.Methods: We searched the English biomedical literature via PubMed, Embase, and Scopus using the terms “smoking and asthma,” “secondhand smoke and asthma,” “environmental tobacco smoke and asthma,” and “smoking/secondhand smoke and corticosteroids.” We also reviewed reference lists of identified articles for relevant citations.Results: In asthmatic patients who smoke, disease control is poorer than in asthmatic nonsmokers. Of all forms of SHS, maternal exposure seems to have the largest impact on asthma by increasing the frequency and severity of the disease and decreasing lung function. Asthmatic children exposed to multiple household smokers face an increased risk for respiratory illness-related absences from school, and these effects persist during adolescence but weaken during adulthood. Airway mucosal permeability is increased in smokers, which could lead to increased clearance of inhaled corticosteroids from the airways. Smokers also have decreased histone deacetylase activity, which is necessary for corticosteroids to fully suppress cytokine production, and can lead to corticosteroid resistance.Conclusions: Cigarette smoking and SHS in asthmatics lead to detrimental effects in patient outcomes and effectiveness of steroid therapy.