Kontakt 2012, 14(2):218-230 | DOI: 10.32725/kont.2012.023

Asthma bronchiale and smokingBiomedicine - Review

Dana Lauková

Fakultná nemocnica Nitra, Oddelenie pneumológie a ftizeológie, Slovenská republika

Effects of active as well as passive smoking are frequently marginally described in terms of possible development of chronic obstructive pulmonary disease (CHOPD). According to the World Health Organization, there are 1.25 milliard smokers worldwide; two thirds of them live in developing countries. There are a number of advanced countries, where at least two thirds of adults are smokers. The smokers mainly include people with low income and low level of education. The assessment of real effects of smoking on asthmatic patients is thus complicated. Trials, which did not exclude smoking asthmatic patients from the research, supported a strong association with the non-atopic type of asthma bronchiale. Smoking of pregnant women increased the rate of occurrence of the asthma development in their children by a factor of 2.5 compared to non-smoking mothers. Active as well as passive smoking also affects the diagnostics and management of the asthma treatment. For example, it causes a reduction in nitrogen oxide (NO) in the air expired. Reduced concentrations of eosinophilous cationic protein in the sputum, increase in neutrophils, macrophages and CD8+ cells in the broncho-alveolar lavage liquid and increased counts of neutrophils, alveolar macrophages, mastocytes and eosinophils in the airway wall were also observed. Smoking modifies inflammatory manifestations typical for asthma. It causes changes in the theophylline metabolism (reduction) and development of corticoresistance. The mechanism of the resistance to corticosteroids has not yet been explained, but it can be caused by a damage to phenotypes of inflammatory cells in the airways, changes in the expression of glucocorticoid receptors (for example enhancement of the glucocorticoid ß-receptor expression) and increase in the activation of inflammatory transcription factors (for example nuclear κB-factor) or reduction in the activity of histone deacetylase. Asthmatic symptoms and their frequency can be thus worsened and the general management of the bronchial asthma treatment becomes more complicated and expensive in smokers.

Keywords: bronchial asthma; smoking; asthma diagnostics and therapy management

Received: February 29, 2012; Accepted: May 11, 2012; Published: June 22, 2012  Show citation