title: Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma.
abstract: BACKGROUND
  One-quarter to one-third of individuals with asthma smoke, which may affect response to therapy and contribute to poor asthma control.
  
  
  OBJECTIVE
  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, double-dummy, 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.
  
  
  RESULTS
  Primary outcome was change in prebronchodilator FEV(1) in smokers versus nonsmokers. Secondary outcomes included peak flow, PC(20) methacholine, symptoms, quality of life, and markers of airway inflammation. Despite similar FEV(1), 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 FEV(1) (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.
authors.affiliation: University of California, San Francisco, 505 Parnassus Avenue, M-1083, San Francisco, CA 94143-0111, USA. lazma@ucsf.edu
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Lazarus
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Rollings
authors.forename: Homer A
authors.initials: HA
authors.lastname: Boushey
authors.forename: Reuben
authors.initials: R
authors.lastname: Cherniack
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Craig
authors.forename: Aaron
authors.initials: A
authors.lastname: Deykin
authors.forename: Emily
authors.initials: E
authors.lastname: DiMango
authors.forename: James E
authors.initials: JE
authors.lastname: Fish
authors.forename: Jean G
authors.initials: JG
authors.lastname: Ford
authors.forename: Elliot
authors.initials: E
authors.lastname: Israel
authors.forename: James
authors.initials: J
authors.lastname: Kiley
authors.forename: Monica
authors.initials: M
authors.lastname: Kraft
authors.forename: Robert F
authors.initials: RF
authors.lastname: Lemanske
authors.forename: Frank T
authors.initials: FT
authors.lastname: Leone
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Martin
authors.forename: Gene R
authors.initials: GR
authors.lastname: Pesola
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Peters
authors.forename: Christine A
authors.initials: CA
authors.lastname: Sorkness
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
authors.forename: Michael E
authors.initials: ME
authors.lastname: Wechsler
authors.forename: John V
authors.initials: JV
authors.lastname: Fahy
mesh_terms: D000085:Acetates / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000627:therapeutic use*; D018592:Cross-Over Studies; D003521:Cyclopropanes; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D011788:Quality of Life; D011804:Quinolines / Q000627:therapeutic use*; D012129:Respiratory Function Tests; D012907:Smoking / Q000009:adverse effects*; D013440:Sulfides; D016896:Treatment Outcome
chemical_list: D000085:Acetates; D003521:Cyclopropanes; D005938:Glucocorticoids; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D001507:Beclomethasone; C093875:montelukast