Chatkin José Miguel, Dullius Cynthia Rocha
Faculdade de Medicina PUCRS; Hospital Sao Lucas PUCRS; Centro Clínico, Av. Ipiranga 6690, Office 501, Porto Alegre, RS CEP 90610-000 Brazil.
Asthma Res Pract. 2016 Jun 20;2:10. doi: 10.1186/s40733-016-0025-7. eCollection 2016.
Asthma is still a major public health problem in most countries; new strategies to better control this disease are necessary. Such strategies must include predisposing factors. One of these factors is smoking and a significant fraction of asthmatics are smokers. However, clinical trials studying new drugs or newer therapeutic regimens for asthma generally exclude smokers. Therefore, there is a lack of specific information about the treatment of asthma in smokers. The asthmatic smoker is a special phenotype with important therapeutic and prognostic clinical implications. Any form of tobacco use, especially cigarette smoking, plays an important role in this disease. Asthmatic smokers are prone to several negative outcomes. Smoking cessation results in an improvement of symptoms and pulmonary functioning. Counselling and first-line medications for smoking cessation (nicotine replacement therapy, bupropion and varenicline) significantly increase quitting rates. The role of electronic cigarettes in this group of patients has only begun to be studied. The treatment of asthmatics that smoke has characteristics that need must be well understood by clinicians, especially the poor response to corticosteroids. This condition is not universal and physicians should always consider its inclusion in the treatment of these patients. The association of inhaled corticosteroids (ICS) plus a long-acting beta2 adrenegic (LABA) by smoking asthmatics results in more pronounced improvement in several asthma outcomes compared with the use of corticosteroid alone. Inhaled corticosteroids in extra-fine particles associated with LABA may be a new perspective of treatment. Also the use of leukotriene antagonists may become another therapeutic alternative. The purpose of this narrative review is to discuss the challenges faced by clinicians to control asthma in smokers and to present methods of coping with smoking treatment and avoiding relapses.
在大多数国家，哮喘仍是一个主要的公共卫生问题；需要新的策略来更好地控制这种疾病。此类策略必须包括诱发因素。其中一个因素是吸烟，相当一部分哮喘患者是吸烟者。然而，研究哮喘新药或更新治疗方案的临床试验通常将吸烟者排除在外。因此，缺乏关于吸烟者哮喘治疗的具体信息。哮喘吸烟者是一种特殊的表型，具有重要的治疗和预后临床意义。任何形式的烟草使用，尤其是吸烟，在这种疾病中都起着重要作用。哮喘吸烟者容易出现多种负面结果。戒烟可改善症状和肺功能。戒烟咨询和一线药物（尼古丁替代疗法、安非他酮和伐尼克兰）可显著提高戒烟率。电子烟在这组患者中的作用才刚刚开始研究。吸烟哮喘患者的治疗具有一些特点，临床医生必须充分了解，尤其是对皮质类固醇反应不佳这一点。这种情况并非普遍存在，医生在治疗这些患者时应始终考虑到这一点。与单独使用皮质类固醇相比，吸烟哮喘患者联合吸入皮质类固醇（ICS）和长效β2肾上腺素能激动剂（LABA）可在多个哮喘指标上带来更显著的改善。与LABA联合使用的超细颗粒吸入皮质类固醇可能是一种新的治疗视角。白三烯拮抗剂的使用也可能成为另一种治疗选择。本叙述性综述的目的是讨论临床医生在控制吸烟者哮喘方面面临的挑战，并介绍应对吸烟治疗和避免复发的方法。
