The Impaction Of Smoking On Asthma And The Effect Of Leukotriene Receptor Antagonist In Asthma With Smoking

BackgroundThe prevalence of active smoking among individuals with asthma is approximately the same as in the population at large. Multiple outcomes are worsened when patients with asthma are exposed to cigarette smoke,which makes asthma difficultly controlled. Active smoking interferes with the response to corticosteroids. How dose smoking impact asthma? What is the effect of leukotriene receptor antagonist to smokers? Limited data is available in domestic or overseas research.ObjectiveIn order to investigate the condition of smoking among asthmatic patients, its impaction on asthma and mechanism of leukotriene receptor antagonist working on smokers, we compare asthma control, airway inflammatory markers and urine LTE4 between the two groups.Methods1.A questionnaire, conducted among patients from Zhongshan Hospital, was used in this study.2.20 asthmatic smokers and 17 asthmatic nonsmokers from asthma specialty clinics in Zhongshan Hospital included in this study. Clinical data of patients was recorded,then the patients entered a 4-week budesonide(Pulmicort Turbuhaler) washout period. After washout, ACT, lung function, FeNO, blood routine examination, blood serum IgE, urine creatinine, urine LTE4, cotinine and induced sputum were measured to compare between the two groups.3.Then the smokers used both budesonide and montelukast(Singulair) for two months to investigate the markers again.Results1.Rates of current smoking,former smoking and passive smoking among asthmatic patients were 13.3%,16.8% and 26.5%.20.97% of male patients were smokers. 3.92% of female patients were smokers, while 36.27% of which were passive smokers. Current smokers comprised 16.67% of male asthmatic patients aged 16 to 40years, 30.16% for ages 41 to 60 years, and 6.67% for ages 61 to 84(p<0.05).ACT, acute exacerbation in last 1 year and dosage of ICS differed signigicantly between smokers(19.92±4.77points,2.67±3.28/year,454.55±103.41μg/d) and nonsmokers(21.89±3.73points,1.87±2.94/year,382.37±151.05μg/d)(p<0.05).No statistical significance was found in FEV1%,allergic and family history between the two groups.2.Compared with the nonsmokers, the proportion of male was larger in smokers(p<0.05).There were no differences in age, onset age, asthma history, allergic and family history. Onset of asthma(mean 32.75 year-old) was later than that of smoking(mean 21.15 year-old). Acute exacerbation in last 1 year differed signigicantly between smokers(1.80±1.88/year) and nonsmokers(0.76±1.44/year)(p<0.05). No statistical significance was found in ACT, FEV1% and FeNO between the two groups. There were no significant differences were found in blood eosinophil count,blood serum IgE, sputum eosinophil, marcrophage, neutrophil count and IL-8, ECP in supernatant liquid of sputum between the two groups.But TNF-a(39.60±13.32pg/ml) and urine LTE4(203.25±136.3pg/mgCr) reached statistical significance(p<0.05),which were higher in smokers. And LTE4 in smokers was linearly correlated with the quantity and time of smoking(r=0.521,p=0.032).In nonsmokers, there was a linear correlation beteewn FeNO and IgE(r=0.693,p=0.006),while it did not exist in smokers. There were no correlation between FEV1%,sputum eosinophil, neutrophil count, IL-8 and the quantity and time of smoking.3.17 smokers finished second period follow-up. No statistical significance was found in FEV1%,FeNO, blood eosinophil count, blood serum IgE, sputum eosinophil, marcrophage, neutrophil count and IL-8,ECP in supernatant liquid of sputum between starting and end point. ACT(20.31±2.82points) and urine LTE4(222.52±141.88 pg/mgCr) differed significantly in smokers after usage of montelukast(p<0.05).Conclusions1.20.97% of male patients were smokers.3.92% of female patients were smokers, while 36.27% of which were passive smokers.2.Onset of asthma was later than that of smoking. It's more difficult to control asthma in smoking group.3.Acute exacerbation in last 1 year differed signigicantly between smokers and nonsmokers,which was more in smokers. TNF-a and urine LTE4 reached statistical significance, which were higher in smokers. LTE4 in smokers was positively correlated with the quantity and time of smoking.4. ACT and urine LTE4 differed significantly in smokers after usage of montelukast. ACT was higher while urine LTE4 was lower,which suggested that asthma was partly controlled.