Smoking asthmatics, a neglected large phenotype of asthmatic patients

Abstract

Introduction: Smoking in asthma patients is an important factor contributing to worsened control of asthma. Despite increased awareness of the harmful effects of smoking in patients with asthma, a signifi cant proportion of asthmatics remain smokers. Here, we present fi ndings from the Still Fighting for Breath global survey regarding the prevalence of smoking in patients with severe asthma, impact of smoking on asthma control and correlation of smoking with different aspects of quality of life in patients with severe persistent asthma. Methods: This online survey conducted by GfK Switzerland in 2016 collected data from 1333 adults (>18 years) and caregivers of children (6-17 years) with severe persistent asthma in 9 countries. Results: Our results showed that smoking was common in asthma patients with 46% of adult patients either current smoker (20%), ex-smoker (24%) or e-cigarette smokers (2%).The proportion of patients with asthma who were current smokers/ ex-smokers or e-cigarette smokers was higher than in the general population in many countries. Overall, 63% of adult patients avoided smoky premises; however, 20% of adults were active smokers .Current smokers with asthma were signifi cantly more frequently diagnosed with anxiety (47%) and depression (41%) than non-smokers (40% and 27%, respectively) and ex-smokers (42% and 28%, respectively). A positive correlation was observed between the number of days that patients with severe asthma used OCS and asthma control according to both the Global Initiative for Asthma (GINA)defi ned control (Spearman's rho=0.24, P<0.001) and patient-perceived control (Spearman's rho=0.13, P< 0.001). Conclusion: This survey shows a high prevalence of smoking in patients with severe persistent asthma. Smoking was associated with increased risk of anxiety/depression and show slight increase in use of oral corticosteroid in these patients. These highlight the need for improved strategies for better management of the disease in smokers with severe persistent asthma.