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t a y b M moking is an independent risk factor for the develpment of asthma symptoms,1 loss of lung function,2 nd asthma exacerbations.3 The mechanisms of smokingelated lung disease can include increased small-airway nflammation with neutrophils and macrophages, airway yper-responsiveness, and airflow obstruction.4,5 Additionlly, patients with asthma who smoke have a reduced esponse to inhaled corticosteroids.6 The effect of smoking n asthmatic lungs also appears to increase the developent of features of chronic obstructive pulmonary disease COPD), and there is an increasing body of knowledge about n asthma-COPD overlap syndrome. Most adults who smoke egularly started the habit as adolescents. The Global Iniiative for Asthma (GINA) guidelines stresses the critical mportance of identifying modifiable risk factors for exacerations, such as smoking.7 It also asks healthcare providers o encourage smokers to quit at every visit and provide ccess to counseling and resources.

Smoking: it's still a big problem in children with asthma