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Published ahead of print on July 31, 2003, doi:10.1164/rccm.200304-503OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 11, December 2003, 1308-1311

A more recent version of this article appeared on December 1, 2003
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Submitted on April 15, 2003
Accepted on July 29, 2003

Cigarette Smoking Impairs The Therapeutic Response To Oral Corticosteroids In Chronic Asthma

Rekha Chaudhuri1, Eric Livingston1, Alex D McMahon2, Lorna Thomson1, William Borland3, and Neil C Thomson1*

1 Respiratory Medicine, University of Glasgow, Glasgow, United Kingdom, 2 Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom, 3 Biochemistry, University of Glasgow, Glasgow, United Kingdom

* To whom correspondence should be addressed. E-mail: n.c.thomson{at}clinmed.gla.ac.uk.

The study was designed to assess the effect of cigarette smoking on the therapeutic response to oral corticosteroids in chronic stable asthma. We performed a randomized, placebo-controlled, crossover study, with prednisolone (40 mg daily) or placebo for 2 weeks in asthmatic smokers, ex-smokers and never-smokers. All subjects had reversibility in forced expiratory flow in one second (FEV1) after nebulized albuterol of >=15% and a mean post-bronchodilator FEV1% predicted > 80%. Efficacy was assessed using FEV1, daily peak expiratory flow (PEF) and an asthma control score. There was a significant improvement following oral prednisolone compared to placebo in FEV1, ml [mean difference (95% confidence intervals), 237 (43,231), p=0.019]; morning PEF L/m [36.8 (11,62), p=0.006] and asthma control score [-0.72 (-1.2, -0.3), p=0.004] in asthmatic never smokers but no change in asthmatic smokers (mean differences 47, 6.5 and - 0.05 with p values 0.605, 0.47 and 0.865 respectively). Asthmatic ex-smokers had a significant improvement in morning and night PEF [mean difference (confidence intervals) 29.1 (2.3,56), p=0.04 and 52.4 (26,79), p=0.003] respectively, but not in FEV1 or asthma control score. We conclude that active smoking impairs the efficacy of short-term oral corticosteroid treatment in chronic asthma.
Key words: corticosteroid resistance, asthma, smoking




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