title: Smoking asthma phenotype: diagnostic and management challenges.
abstract: OBJECTIVE
  The prevalence of active smoking in adults with asthma is similar to the general population. Smoking asthma is associated with poorer disease control, impaired response to corticosteroid therapy, accelerated decline in lung function, and increased rate of healthcare utilization. Current asthma guidelines do not provide specific treatment advice for smoking asthmatic patients. There is an urgent need for better understanding of the underlying mechanisms and effective treatment for smoking asthmatic patients.
  
  
  RESULTS
  An association between both active and passive smoking and adult-onset asthma is supported by many studies.The asthma-COPD overlap syndrome (ACOS) has recently gained particular interest and smoking asthmatic patients should be evaluated for ACOS.Treatment regimens for smoking asthma include higher doses of inhaled corticosteroids (ICS), extrafine particle ICS formulations, antileukotrienes, and combinations of these options.Asthma is associated with increased risk of cardiovascular comorbidities whereas smoking is an additional strong independent risk factor for pulmonary and cardiovascular diseases. Tobacco smoking and not asthma per se seems to be the reason of poor prognosis, especially with regard to lung cancer, cardiovascular diseases, and mortality in asthmatic patients.
  
  
  CONCLUSIONS
  Smoking asthma represents a common challenge to the clinician both in terms of diagnosis and management. These aspects have not been thoroughly evaluated and deserve further investigation.
authors.affiliation: 1st University Department of Respiratory Medicine, University of Athens, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Bakakos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kostikas
authors.forename: Stelios
authors.initials: S
authors.lastname: Loukides
mesh_terms: D017668:Age of Onset; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D010641:Phenotype; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome