Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, Netherlands.
BMC Pulm Med. 2013 Sep 22;13:58. doi: 10.1186/1471-2466-13-58.
It has been suggested that smoking asthmatics benefit less from corticosteroid treatment than never-smoking asthmatics. We investigated differences in blood and sputum inflammatory profiles between ex-, current-, and never-smokers and assessed their ICS treatment response after 2-week and 1-year treatment.
We analyzed FEV1, PC20 methacholine and PC20 AMP, (differential) cell counts in sputum and blood in ex-, current- and never-smokers at baseline (n=114), after 2-week treatment with fluticasone 500 or 2000 μg/day (n=76) and after 1-year treatment with fluticasone 500 μg/day or a variable dose of fluticasone based on a self-management plan (n=64).
A total of 114 patients were included (29 ex-, 30 current- and 55 never-smokers. At baseline, ex- and current-smokers had less eosinophils in sputum and blood than never-smokers. Blood neutrophil counts were higher in current- than in never-smokers. A higher number of cigarettes smoked daily was associated with lower blood and sputum eosinophils. After 2-week ICS treatment, FEV1 %predicted improved less in current-smokers than never-smokers (2.4% versus 8.1%, p=0.010) and ex-smokers tended to improve less than never-smokers (4.1%, p=0.067). In contrast, no differences in ICS treatment response in lung function or inflammatory cells were found between the three groups after 1 year.
Ex- and current-smokers have less eosinophils and more neutrophils in their sputum and blood than never-smokers. Although ex- and current-smokers have a reduced short-term corticosteroid treatment response, we did not find a difference in their long-term treatment response.
有研究表明，与从不吸烟的哮喘患者相比，吸烟哮喘患者从皮质类固醇治疗中获益较少。我们研究了既往吸烟者、当前吸烟者和从不吸烟者之间血液和痰液炎症特征的差异，并评估了他们在接受 2 周和 1 年治疗后对 ICS 的治疗反应。
我们分析了 FEV1、PC20 乙酰甲胆碱和 PC20 AMP、痰液和血液中的（差异）细胞计数，纳入了 114 名基线时的既往吸烟者、当前吸烟者和从不吸烟者（n=114），其中 76 名接受了 2 周氟替卡松 500 或 2000μg/天治疗（n=76），64 名接受了氟替卡松 500μg/天或根据自我管理计划使用可变剂量氟替卡松治疗 1 年（n=64）。
共纳入 114 例患者（29 例既往吸烟者、30 例当前吸烟者和 55 例从不吸烟者）。基线时，既往吸烟者和当前吸烟者的痰液和血液中嗜酸性粒细胞少于从不吸烟者。当前吸烟者的血液中性粒细胞计数高于从不吸烟者。每天吸烟的支数与血液和痰液中的嗜酸性粒细胞呈负相关。接受 2 周 ICS 治疗后，当前吸烟者的 FEV1%预测值改善低于从不吸烟者（2.4%对 8.1%，p=0.010），而既往吸烟者的改善程度低于从不吸烟者（4.1%，p=0.067）。相反，三组患者在肺功能或炎症细胞方面，1 年后 ICS 治疗反应无差异。
既往吸烟者和当前吸烟者的痰液和血液中嗜酸性粒细胞较少，中性粒细胞较多。尽管既往吸烟者和当前吸烟者的短期皮质类固醇治疗反应降低，但我们未发现他们在长期治疗反应方面的差异。
