title: Smoking and nonsmoking asthma: differences in clinical outcome and pathogenesis.
abstract: Cigarette smoking in asthma is frequently present and is associated with worsening of symptoms, accelerated lung-function decline, a higher frequency of hospital admissions, a higher degree of asthma severity, poorer asthma control and reduced responsiveness to corticosteroids. Furthermore, it is associated with reduced numbers of eosinophils and higher numbers of mast cells in the submucosa of the airway wall. Airway remodeling is increased as evidenced by increased epithelial thickness and goblet cell hyperplasia in smoking asthmatics. The pathogenesis responsible for smoking-induced changes in airway inflammation and remodeling in asthma is complex and largely unknown. The underlying mechanism of reduced corticosteroid responsiveness is also unknown. This article discusses differences between smoking and nonsmoking asthmatics regarding the clinical expression of asthma, lung function, response to corticosteroids, airway inflammation and remodeling processes. Possible pathogenetic mechanisms that may explain the links between cigarette smoking and changes in the clinical expression of asthma will be discussed, as well as the beneficial effects of smoking cessation.
authors.affiliation: Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Fattahi
authors.forename: Machteld N
authors.initials: MN
authors.lastname: Hylkema
authors.forename: Barbro N
authors.initials: BN
authors.lastname: Melgert
authors.forename: Wim
authors.initials: W
authors.lastname: Timens
authors.forename: Dirkje S
authors.initials: DS
authors.lastname: Postma
authors.forename: Nick H T
authors.initials: NH
authors.lastname: ten Hacken
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008168:Lung / Q000473:pathology / Q000503:physiopathology; D011379:Prognosis; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones