TY - JOUR T1 - GINA recommendations in adults with symptomatic mild asthma and a smoking history JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00068-2020 VL - 55 IS - 2 SP - 2000068 AU - Helen K. Reddel Y1 - 2020/02/01 UR - http://erj.ersjournals.com/content/55/2/2000068.abstract N2 - 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 ER -