N.C. Thomson and R. Chaudhuri raise an important issue about treatment recommendations for patients with asthma who have a significant smoking history. The exclusion of such patients from most asthma studies appears to have largely been driven by the requirement by regulators for pure “asthma” and “COPD” populations in pharmacotherapy studies that are designed for obtaining regulatory approval. However, once that is obtained, there is an important need for additional clinical trials to be performed in broader populations, and with more pragmatic designs, to increase the generalisability of evidence to clinical practice. Considering the large number of randomised controlled trials in asthma in the past 20 years, very few studies have included patients with a significant smoking history; N.C. Thomson and R. Chaudhuri are to be commended for their work in this area. The 2019 GINA recommendations are supported by clinical trials in >10000 mild asthma patients. For any treatment decision, GINA recommends that clinicians should consider individual patient characteristics/risk factors as part of shared decision making. http://bit.ly/2ZqboJ2

中文翻译：

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GINA 对有症状的轻度哮喘和吸烟史成人的建议

NC Thomson 和 R. Chaudhuri 提出了一个关于对有明显吸烟史的哮喘患者的治疗建议的重要问题。从大多数哮喘研究中排除此类患者似乎主要是由于监管机构要求在旨在获得监管批准的药物治疗研究中对纯“哮喘”和“COPD”人群的要求。然而，一旦获得，就需要在更广泛的人群中进行额外的临床试验，并采用更务实的设计，以增加证据对临床实践的普遍性。考虑到过去 20 年中大量的哮喘随机对照试验，很少有研究纳入有明显吸烟史的患者；NC 汤姆森和 R. Chaudhuri 在这方面的工作值得表扬。2019 年 GINA 建议得到了超过 10000 名轻度哮喘患者的临床试验的支持。对于任何治疗决定，GINA 建议临床医生应将个体患者特征/风险因素作为共同决策的一部分。http://bit.ly/2ZqboJ2