Corticosteroid insensitivity in smokers with asthma: Clinical evidence, mechanisms, and management

Neil C. Thomson (Lead / Corresponding author), Malcolm Shepherd, Mark Spears, Rekha Chaudhuri

Research output: Contribution to journalReview articlepeer-review

28 Citations (Scopus)


Corticosteroids are the most effective treatment for asthma, but the therapeutic response varies considerably between individuals. Several clinical studies have found that smokers with asthma are insensitive to the beneficial effects of short- to medium-term inhaled corticosteroid treatment compared with non-smokers with asthma. It is estimated that 25% of adults in most industrialized countries smoke cigarettes, and similar surveys amongst asthmatic individuals suggest that the prevalence of smoking in this grouping mirrors that found in the general population. Therefore, cigarette smoking is probably the most common cause of corticosteroid insensitivity in asthma. Cigarette smoking and asthma are also associated with poor symptom control and an accelerated rate of decline in lung function. The mechanism of corticosteroid insensitivity in smokers with asthma is currently unexplained but could be due to alterations in airway inflammatory cell phenotypes, changes in glucocorticoid receptor α/β ratio, and/or reduced histone deacetylase activity. Smoking cessation should be encouraged in all smokers with asthma. Short-term benefits include improvements in lung function and asthma control. However, the numbers of sustained quitters is disappointingly small. Additional or alternative drugs need to be identified to treat those individuals who are unable to stop smoking or who have persistent symptoms following smoking cessation.

Original languageEnglish
Pages (from-to)467-481
Number of pages15
JournalTreatments in Respiratory Medicine
Issue number6
Publication statusPublished - Dec 2006

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


Dive into the research topics of 'Corticosteroid insensitivity in smokers with asthma: Clinical evidence, mechanisms, and management'. Together they form a unique fingerprint.

Cite this