The influence of inhaled corticosteroids on asthma control test in smokers and non-smokers with asthma

Smoking in asthmatics is responsible for the worsening of asthma symptoms, more frequent asthma exacerbations and hospitalizations and lowered quality of life. In smoking asthmatics the designated doses of the inhaled corticosteroid treatment are usually insufficient to accomplish total asthma control. Out of 54 screened adult patients up to 50 years old with mild asthma, 38 were involved in the study. They were divided in two groups: smokers and non-smokers. They received a total daily dosage of 500 µg of inhaled fluticasone propionate. A rescue medication, a short-acting ß2 agonist (salbutamol) in a dosage of 0.1 mg/per inhaled dose, was used when needed. Asthma was diagnosed by a positive metacholine provocation test and/or a positive bronchodilatator response. An asthma control test i.e. the ACT-TM questionnaire was performed before the beginning of the study and 6 weeks after the treatmentwith fluticasone propionate of the previous corticosteroid-naive patients. A statistically positive response (p<0.05) was reached in favor of non-smoking asthmatics. It can be concluded that ACT is a reliable tool to assess the effect of the topical corticosteroid treatment in non-smoking and smoking asthmatics. An achievement of better asthma control could be expected among both of the examined groups, but the effect of the intervention in the therapy is estimated to be more expressed within the group of asthmatic non-smokers. In smoking asthmatics there is a need for other therapeutic modalities such as increasing the dosage of inhaled corticosteroids, usageof combination therapy and/or adding low doses of aminophylline.