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Corticosteroid Insensitivity in Smokers with Asthma

Clinical Evidence, Mechanisms, and Management

  • Review Article
  • Published:
Treatments in Respiratory Medicine

Abstract

Corticosteroids are the most effective treatment for asthma, but the therapeutic response varies considerably between individuals. Several clinical studies have found that smokers with asthma are insensitive to the beneficial effects of short- to medium-term inhaled corticosteroid treatment compared with non-smokers with asthma. It is estimated that 25% of adults in most industrialized countries smoke cigarettes, and similar surveys amongst asthmatic individuals suggest that the prevalence of smoking in this grouping mirrors that found in the general population. Therefore, cigarette smoking is probably the most common cause of corticosteroid insensitivity in asthma. Cigarette smoking and asthma are also associated with poor symptom control and an accelerated rate of decline in lung function. The mechanism of corticosteroid insensitivity in smokers with asthma is currently unexplained but could be due to alterations in airway inflammatory cell phenotypes, changes in glucocorticoid receptor α/β ratio, and/or reduced histone deacetylase activity. Smoking cessation should be encouraged in all smokers with asthma. Short-term benefits include improvements in lung function and asthma control. However, the numbers of sustained quitters is disappointingly small. Additional or alternative drugs need to be identified to treat those individuals who are unable to stop smoking or who have persistent symptoms following smoking cessation.

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Table I

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Notes

  1. 1 The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

We would like to thank Asthma UK and Chest Heart & Stroke (Scotland) for their support and Kathy McFall from the Medical Illustration Departments at the Western Infirmary and Gartnavel General for assistance with the figures. No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest directly relevant to the content of this article.

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  1. Department of Respiratory Medicine, Division of Immunology, Infection and Inflammation, Western Infirmary and University of Glasgow, Gartnavel General Hospital, 1053 Gt Western Rd, Glasgow, G12 OYN, Scotland

    Neil C. Thomson, Malcolm Shepherd, Mark Spears & Rekha Chaudhuri

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  1. Neil C. Thomson
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  2. Malcolm Shepherd
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  3. Mark Spears
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  4. Rekha Chaudhuri
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Correspondence to Neil C. Thomson.

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Thomson, N.C., Shepherd, M., Spears, M. et al. Corticosteroid Insensitivity in Smokers with Asthma. Treat Respir Med 5, 467–481 (2006). https://doi.org/10.2165/00151829-200605060-00010

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