Randomized trial of allergen-induced asthmatic response in smokers and non-smokers: effects of inhaled corticosteroids
Summary Background It is thought that asthmatics who smoke cigarettes respond less well to inhaled corticosteroid (ICS) therapy than asthmatics who do not smoke. Objective To evaluate the effects of smoking on allergen‐induced airway responses in asthmatics treated with ICS. Methods Randomized, doub...
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Published in | Clinical and experimental allergy Vol. 45; no. 10; pp. 1531 - 1541 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Blackwell Publishing Ltd
01.10.2015
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Summary
Background
It is thought that asthmatics who smoke cigarettes respond less well to inhaled corticosteroid (ICS) therapy than asthmatics who do not smoke.
Objective
To evaluate the effects of smoking on allergen‐induced airway responses in asthmatics treated with ICS.
Methods
Randomized, double‐blind, crossover study evaluating twice daily fluticasone propionate (FP) 100 μg, FP 500 μg and placebo, for 7 days, on allergen‐induced asthmatic responses in 18 non‐smoking and 17 smoking atopic asthmatics (NCT01400906). At 1 h post‐morning dose on Day 6, forced expiratory volume in 1 sec (FEV1) was measured up to 10 h post‐challenge. Exhaled nitric oxide (eNO), induced sputum cell counts, and responsiveness to methacholine were assessed the following day.
Results
The late asthmatic response (LAR) was suppressed by FP in smokers and non‐smokers; with placebo, the LAR was also attenuated in smokers versus non‐smokers (adjusted mean minimum change in FEV1 (L) over 4–10 h [95% CI] in non‐smokers: placebo −1.01 [1.31, 0.70], FP 100 μg −0.38 [0.54, 0.22], FP 500 μg −0.35 [0.54–0.22]; and in smokers: placebo −0.63 [0.84, 0.43]; FP 100 μg −0.44 [0.65, 0.23]; FP 500 μg −0.46 [0.59–0.32]). The Early AR was suppressed by FP treatment in non‐smokers, but was not impacted in smokers. The reduction in methacholine hyperresponsiveness after FP was greater in non‐smokers (1.5‐ and twofold doubling dose difference from placebo after FP 100 μg and FP 500 μg) than smokers (1.0 and 1.3 difference, respectively). Allergen‐induced increases in eNO and sputum eosinophils were lower in smokers than non‐smokers and were suppressed in both groups by FP.
Conclusion and Clinical Relevance
Allergen‐induced LARs were of a similar amplitude in both smoking and non‐smoking atopic asthmatics at the end of ICS treatment, but attenuation of the LAR in smokers was only partly associated with ICS treatment. The marked attenuation of the LAR observed in smokers in the absence of ICS treatment is a novel observation. |
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Bibliography: | istex:352E6C8537E768F06DF41F06AFF3204B732DD57E ark:/67375/WNG-HL60C754-W ArticleID:CEA12610 GlaxoSmithKline (GSK) - No. NCT01400906 Figure S1. Allergen challenge time course of mean change in post-saline FEV1 (95% CI) on Day 6 of a) placebo, b) FP 100µg bd and c) FP 500 µg bd, in non-smokers and smokers excluding 8 protocol violators Figure S2. Adjusted mean treatment differences (95% CI) in post-saline FEV1 by time on Day 6 following treatment with a) FP 100µg bd and b) FP 500 µg bd Figure S3. Adjusted mean allergen challenge time course of change in post-saline FEV1 (95% CI) on Day 6 of a) placebo, b) FP 100µg bd and c) FP 500 µg bd in non-smokers and smokers excluding subjects challenged with grass pollen Figure S4. Adjusted Geometric Means (95% CI) of sputum neutrophil cell count post allergen challenge on Day 7Table S1. Details of screening allergen challenge protocol violators Table S2. Summary of loge transformed exhaled No data (ppb ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23 |
ISSN: | 0954-7894 1365-2222 |
DOI: | 10.1111/cea.12610 |