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Published online before print August 9, 2006
Eur Respir J 2006, doi:10.1183/09031936.06.00120505
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ORIGINAL ARTICLE

Systemic sensitivity to corticosteroids in smokers with asthma

E. Livingston 1, R. Chaudhuri 1, A. D McMahon 2, I. Fraser 3, C.P. McSharry 3, N.C. Thomson 1*

1 Depts of Respiratory Medicine
2 Robertson Centre for Biostatistics, Glasgow, UK
3 Immunology, University of Glasgow


  Abstract

Cigarette smokers with asthma are insensitive to the therapeutic effects of corticosteroids. It is unknown whether insensitivity to corticosteroids in smokers affects tissue sites outwith the airways.

75 asthmatic subjects (39 smokers) and 78 healthy controls (30 smokers) were recruited to an observational study where the cutaneous and peripheral blood lymphocyte responses to corticosteroids were measured. The cutaneous vasoconstrictor response to topical beclometasone was measured by applying different concentrations of beclometasone solutions to the skin in a random double blind manner. The degree of blanching at each concentration was graded after 18 hours. Sensitivity of peripheral blood lymphocytes to corticosteroids was assessed by measuring the suppressive effect of dexamethasone on lymphocyte proliferation stimulated by phytohaemagglutinin.

Total cutaneous vasoconstrictor response score to beclometasone (mean [SD]) was reduced in smokers (5.39 [3.58]) compared to never-smokers (7.26 [3.05]) with asthma, p=0.023, and in all smokers (6.47 [3.33]) compared to all never-smokers (7.86 [2.81]), p=0.006. The sensitivity to corticosteroids of lymphocytes stimulated by phytohaemagglutinin was similar between groups.

Smokers with asthma have an impaired cutaneous vasoconstrictor response to topical corticosteroids compared to never-smokers with asthma. This finding suggests the insensitivity to corticosteroids in smokers with asthma affects tissue sites other than the airways.

Keywords:  Asthma, corticosteroid insensitivity, cutaneous vasoconstriction, lymphocyte proliferation, smoking




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