The impact of smoking history on baseline characteristic in patients with severe asthma in the German Asthma Net (GAN).

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-02-01 DOI:10.1016/j.jaip.2025.01.024

Leonie Biener, Slagjana Stoshikj, Jonas Brugger, Christoph Krall, Roland Buhl, Eckard Hamelmann, Stephanie Korn, Christian Taube, Katrin Milger-Kneidinger, Christian Schulz, Hendrik Suhling, Margret Jandl, Rainer Ehmann, Olaf Schmidt, Marco Idzko, Dirk Skowasch

{"title":"The impact of smoking history on baseline characteristic in patients with severe asthma in the German Asthma Net (GAN).","authors":"Leonie Biener, Slagjana Stoshikj, Jonas Brugger, Christoph Krall, Roland Buhl, Eckard Hamelmann, Stephanie Korn, Christian Taube, Katrin Milger-Kneidinger, Christian Schulz, Hendrik Suhling, Margret Jandl, Rainer Ehmann, Olaf Schmidt, Marco Idzko, Dirk Skowasch","doi":"10.1016/j.jaip.2025.01.024","DOIUrl":null,"url":null,"abstract":"Background: Asthma patients with >10 pack-years are frequently excluded from asthma trials. Little is known about how smoking affects their characteristics, and therefore may impact treatment choices.Objective: To evaluate the impact of cumulative smoking history on severe asthma patients' characteristics METHODS: We analysed pulmonary function tests, asthma control, exacerbation rate and biomarkers. We compared active and ex-smokers (=ever-smokers) vs. never-smokers and performed linear models for three groups stratified by smoking history (<10 pack-years (py), 10-20 py, >20 py). Data was obtained from the severe asthma registry German Asthma Net (GAN).Results: We included 2.478 patients: 65 (2.6%) active smokers, 1.005 (40.6%) ex-smokers and 1.408 (56.8%) never-smokers. Of the 1070 ever-smokers, 529 patients (21.3%) had <10 py, 304 (12.3%) 10-20 py and 237 (9.6%) >20 py. Cumulative smoking history was associated with worse asthma control (>20 py: ACT -1.76 [-2.76; -0.77] points (p <.001); mini-AQLQ -0.31 [-0.53; -0.10] points (p=0.004)), while exacerbation rate and maintenance oral corticosteroid (OCS) doses were similar (p=.13 and p=1.0). Cumulative smoking history was associated with smoking-related lung injury e.g. DLCO (-0.37 mmol/min/kPa for 10-20 py (p=.014) respectively -0.92 for >20 py (p<.001)), but FEV1 and FEV1-reversibility were similar. Cumulative smoking history was furthermore associated 0.84- [0.73; 0.97] fold lower FeNO concentrations (p=.007) while blood eosinophil count and IgE-levels were comparable (BEC p=1.0, IgE p=.49) CONCLUSION: Cumulative smoking history in asthma patients is associated with worse disease control, lower FeNO levels and smoking-related lung-injuries. Despite these differences, key asthma characteristics like BEC, IgE, OCS dose and exacerbation rates remain similar. If thoroughly examined and selected, patients with >10 py may also qualify for targeted treatments.","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Allergy and Clinical Immunology-In Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jaip.2025.01.024","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Asthma patients with >10 pack-years are frequently excluded from asthma trials. Little is known about how smoking affects their characteristics, and therefore may impact treatment choices.

Objective: To evaluate the impact of cumulative smoking history on severe asthma patients' characteristics METHODS: We analysed pulmonary function tests, asthma control, exacerbation rate and biomarkers. We compared active and ex-smokers (=ever-smokers) vs. never-smokers and performed linear models for three groups stratified by smoking history (<10 pack-years (py), 10-20 py, >20 py). Data was obtained from the severe asthma registry German Asthma Net (GAN).

Results: We included 2.478 patients: 65 (2.6%) active smokers, 1.005 (40.6%) ex-smokers and 1.408 (56.8%) never-smokers. Of the 1070 ever-smokers, 529 patients (21.3%) had <10 py, 304 (12.3%) 10-20 py and 237 (9.6%) >20 py. Cumulative smoking history was associated with worse asthma control (>20 py: ACT -1.76 [-2.76; -0.77] points (p <.001); mini-AQLQ -0.31 [-0.53; -0.10] points (p=0.004)), while exacerbation rate and maintenance oral corticosteroid (OCS) doses were similar (p=.13 and p=1.0). Cumulative smoking history was associated with smoking-related lung injury e.g. DLCO (-0.37 mmol/min/kPa for 10-20 py (p=.014) respectively -0.92 for >20 py (p<.001)), but FEV1 and FEV1-reversibility were similar. Cumulative smoking history was furthermore associated 0.84- [0.73; 0.97] fold lower FeNO concentrations (p=.007) while blood eosinophil count and IgE-levels were comparable (BEC p=1.0, IgE p=.49) CONCLUSION: Cumulative smoking history in asthma patients is associated with worse disease control, lower FeNO levels and smoking-related lung-injuries. Despite these differences, key asthma characteristics like BEC, IgE, OCS dose and exacerbation rates remain similar. If thoroughly examined and selected, patients with >10 py may also qualify for targeted treatments.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.