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Editorials |

Asthma Guidelines and SmokersAsthma Guidelines and Smokers: It’s Time to Be Inclusive

Neil C. Thomson, MD; Mark Spears, PhD
Author and Funding Information

From the Department of Respiratory Medicine, Institute of Infection, Immunity, and Inflammation, University of Glasgow and Gartnavel General Hospital.

Correspondence to: Neil C. Thomson, MD, Respiratory Medicine, Institute of Infection, Immunity, and Inflammation, University of Glasgow and Gartnavel General Hospital, Glasgow, G12 OYN, Scotland; e-mail: neil.thomson@glasgow.ac.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Thomson has received institutional grant funding from Asthmatx, AstraZeneca, GlaxoSmithKline, Merck, Novartis, Pfizer, and Synairgen. Dr Spears has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(2):286-288. doi:10.1378/chest.11-1424
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A limitation to the recommendations on drug treatment made in asthma guidelines is that these are based on clinical studies performed in selected groups of patients.1 For example, in many trials, only 5% of adults with asthma fulfill the entry criteria; current smokers or former heavy smokers are usually excluded.2 The lack of information on the best approach to manage smokers is of considerable importance, given the high prevalence rates of active smoking in asthma and the poor levels of asthma control in this group.3 In developed countries, one-fifth to one-third of adults with asthma are smokers, and in some areas of the world, such as southeast Asia, almost one-half are smokers. Smokers experience increased morbidity from asthma compared with nonsmokers, including more severe symptoms, increased rates of admission to hospital with acute asthma, and accelerated rates of decline in lung function.3,4 Clinical trials are urgently required that will provide evidence on which drugs and treatment strategies are most appropriate for this group.

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