Department of Clinical Pharmacy, Texas Tech University Health Science Center, Dallas, USA.
J Am Board Fam Med. 2011 May-Jun;24(3):313-22. doi: 10.3122/jabfm.2011.03.100180.
The purpose of this review is to describe the current understanding of the prevalence and adverse effects of cigarette smoking and secondhand smoke (SHS) in asthmatics in terms of patient outcomes and response to inhaled corticosteroids.
We searched the English biomedical literature via PubMed, Embase, and Scopus using the terms "smoking and asthma," "secondhand smoke and asthma," "environmental tobacco smoke and asthma," and "smoking/secondhand smoke and corticosteroids." We also reviewed reference lists of identified articles for relevant citations.
In asthmatic patients who smoke, disease control is poorer than in asthmatic nonsmokers. Of all forms of SHS, maternal exposure seems to have the largest impact on asthma by increasing the frequency and severity of the disease and decreasing lung function. Asthmatic children exposed to multiple household smokers face an increased risk for respiratory illness-related absences from school, and these effects persist during adolescence but weaken during adulthood. Airway mucosal permeability is increased in smokers, which could lead to increased clearance of inhaled corticosteroids from the airways. Smokers also have decreased histone deacetylase activity, which is necessary for corticosteroids to fully suppress cytokine production, and can lead to corticosteroid resistance.
Cigarette smoking and SHS in asthmatics lead to detrimental effects in patient outcomes and effectiveness of steroid therapy.
本综述旨在描述目前对哮喘患者中吸烟和二手烟（SHS）的流行程度及其对患者结局和吸入皮质类固醇反应的不良影响的认识。
我们通过 PubMed、Embase 和 Scopus 以“吸烟与哮喘”“二手烟与哮喘”“环境烟草烟雾与哮喘”和“吸烟/二手烟与皮质类固醇”等术语搜索了英文生物医学文献，并对已确定文章的参考文献列表进行了相关引文的审查。
在吸烟的哮喘患者中，疾病控制情况不如不吸烟的哮喘患者。在所有形式的 SHS 中，母亲暴露似乎对哮喘的影响最大，增加了疾病的频率和严重程度，并降低了肺功能。暴露于多个家庭吸烟者的哮喘儿童面临与呼吸道疾病相关的缺课风险增加，这些影响在青春期持续存在，但在成年期减弱。气道黏膜通透性在吸烟者中增加，这可能导致吸入皮质类固醇从气道中的清除增加。吸烟者还存在组蛋白去乙酰化酶活性降低，这是皮质类固醇充分抑制细胞因子产生所必需的，并且可能导致皮质类固醇抵抗。
哮喘患者中的吸烟和 SHS 会导致患者结局和类固醇治疗效果产生有害影响。
