Background

Asthmatic smokers have reduced quality of life and need frequent specialist visits/hospitalization. Smoking habit represents for asthmatics a higher risk for comorbidities and lung function impairment. The impact of cigarette smoking on asthmatics should be addressed to evaluate the related risk factors.

Methods

This real-life observational study evaluated demographic, clinical/functional, and biological parameters of 521 asthmatic patients stratified as never (0 PY), light (1–10 PY), and heavy smokers (>10PY).

Results

The heavy smokers with asthma were more frequently older, male, overweight, and non-allergic than other asthmatics. Although similar ICS dose and severity among groups, heavy smokers had more significant airflow limitation (FEV₁/FVC = 0.65 ± 0.10, p < 0.01; FEV₁%pred = 79.20 ± 21.20, p < 0.01), air trapping (RV %pred. = 135.6 ± 44.8, p < 0.05; RV/TLC = 0.48 ± 0.12, p < 0.05), and fixed airflow obstruction (post-bronchodilation FEV₁/FVC = 0.66 ± 0.10; p = 0.01) than never and light smokers with asthma. Heavy smokers also demonstrated reduced blood eosinophils (p < 0.05) and FeNO (p < 0.01), increased frequency of type-2 low inflammation and LABA/LAMA use but had less frequently persistent rhinitis and chronic rhinosinusitis with nasal polyposis. Heavy smokers showed higher prevalence of paraseptal/bullous emphysema and arterial hypertension. Considering the risk analysis, heavy smokers showed less chance to have allergy (OR = 0.5), persistent rhinitis (OR = 0.6), chronic rhinosinusitis with nasal polyposis (OR = 0.3), or high FeNO (OR = 0.4), but they were prone to develop fixed airflow obstruction (post-bronchodilation FEV1%pred<80%, OR = 2.0, and post-bronchodilation FEV1/FVC≤0.70, OR = 2.0).

Conclusions

Heavy smokers had more severe obstructive impairments than light and never smokers with similar ICS dose, showing a steroid insensitivity, but displayed less allergy with low FeNO and blood eosinophil count, thus being a definite phenotype.

中文翻译：

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吸烟对现实生活中哮喘的影响。

背景

哮喘吸烟者的生活质量下降，需要经常的专家拜访/住院治疗。吸烟习惯对哮喘患者表示合并症和肺功能损害的较高风险。应对吸烟对哮喘的影响进行评估，以评估相关的危险因素。

方法

这项真实的观察性研究评估了521名哮喘患者的人口统计学，临床/功能和生物学参数，这些患者分层为从不（0 PY），轻度（1-10 PY）和重度吸烟者（> 10PY）。

结果

患有哮喘的重度吸烟者比其他哮喘患者更常见于年龄较大，男性，超重和非过敏性人群。尽管各组间的ICS剂量和严重程度相似，但重度吸烟者的气流受限更为明显（FEV ₁ / FVC = 0.65±0.10，p <0.01; FEV ₁％pred = 79.20±21.20，p <0.01），空气滞留（RV％pred = 135.6±44.8，p <0.05; RV / TLC = 0.48±0.12，p <0.05），且固定气流阻塞（支气管扩张后FEV ₁/ FVC = 0.66±0.10; p = 0.01）比从不吸烟和轻度吸烟者哮喘。大量吸烟者还表现出血液嗜酸性粒细胞减少（p <0.05）和FeNO（p <0.01），2型低发炎和使用LABA / LAMA的频率增加，但是持续性鼻炎和慢性鼻鼻窦炎伴鼻息肉病的发生频率降低。大量吸烟者表现出中隔/大块肺气肿和动脉高血压的患病率较高。考虑风险分析，重度吸烟者出现变态反应（OR = 0.5），持续性鼻炎（OR = 0.6），伴有鼻息肉的慢性鼻-鼻窦炎（OR = 0.3）或高FeNO（OR = 0.4）的机会较少，但他们易于发展为固定的气流障碍（支气管扩张后FEV1％pred <80％，OR = 2.0，支气管扩张后FEV1 /FVC≤0.70，OR = 2.0）。

结论

重度吸烟者比轻度吸烟者有更严重的阻塞性障碍，并且从未吸烟者具有相似的ICS剂量，显示出类固醇不敏感，但在FeNO和血液嗜酸性粒细胞计数较低的情况下却表现出较少的过敏，因此是明确的表型。