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(Chest. 2006;129:661-668.)
© 2006 American College of Chest Physicians

Smoking and Asthma*

Clinical and Radiologic Features, Lung Function, and Airway Inflammation

Louis-Philippe Boulet, MD; Catherine Lemière, MD; Francine Archambault, MD; Guy Carrier, MD; Marie Claire Descary, MD and Francine Deschesnes, BSc

* From the Unité de Recherche en Pneumologie (Drs. Boulet, Archambault, and Carrier, and Ms. Deschesnes), Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Hôpital Laval, Québec City; and Service de Pneumologie (Drs. Lemière and Descary), Hôpital du Sacré-Coeur, Montréal, QC, Canada.

Correspondence to: Louis-Philippe Boulet, MD, Hôpital Laval, 2725, Chemin Sainte-Foy, Québec, QC, Canada, G1V 4G5; e-mail: lpboulet{at}med.ulaval.ca

Abstract

Smoking may influence the type of airway inflammation observed in asthma and its response to therapy. More studies are needed on how smoking-induced changes in lung function/structure and airway inflammation may result in a change in clinical expression. We compared clinical, physiologic, radiologic, and airway inflammatory features of 22 smoking asthma patients (cigarette smoking history, 14.0 ± 7.6 pack-years [mean ± SD]) and 27 nonsmoking asthma patients. Mean age/duration of asthma of smoking and nonsmoking asthma patients were 31 years/14 years and 29 years/17 years, respectively. Quality of life, FEV1, bronchodilator response, perception of bronchoconstriction, and methacholine responsiveness were similar in the two groups. Compared to nonsmoking asthma patients, smokers had more respiratory symptoms, a lower mean forced expiratory flow at 25 to 75% of FVC, FEV1/FVC ratio, and lung diffusion capacity, and a higher functional residual capacity. Induced-sputum neutrophil and bronchial cell counts were higher and exhaled breath condensate pH was more acidic in smoking asthma patients. On high-resolution CT, airway and parenchymal abnormalities were more common in smoking asthma patients than in nonsmokers. In conclusion, compared with nonsmoking asthma patients, smoking asthma patients have features similar to what could be found in early stages of COPD.

Key Words: asthma • COPD • exhaled breath condensate • high-resolution CT • induced sputum • lung diffusion capacity • pH • respiratory symptoms • smoking






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