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Review: Treating patients with respiratory disease who smoke

Department of Respiratory Medicine, Division of Immunology, Infection & Inflammation, University of Glasgow, Glasgow, UK

Rekha Chaudhuri

Department of Respiratory Medicine, Division of Immunology, Infection & Inflammation, University of Glasgow, Glasgow, UK

Neil C. Thomson

Department of Respiratory Medicine, Division of Immunology, Infection and Inflammation, University of Glasgow & Gartnavel General Hospital, Glasgow G12 OYN, UK, n.c.thomson@clinmed. gla.ac.uk

The high prevalence of cigarette smoking in patients with respiratory disease puts them at risk of developing clinically important drug interactions. Cigarette smoking reduces the therapeutic response to certain drugs such as theophyllines through the induction of hepatic cytochrome P450 isoenzymes. Smokers with asthma and patients with COPD have reduced sensitivity to corticosteroids, possibly due to non-eosinophilic airway inflammation, altered glucocorticoid receptor activity or reduced histone deacetylase activity. Although all smokers should be encouraged to stop smoking, there is limited information on the influence of smoking cessation on the therapeutic and anti-inflammatory effects of a number of the drugs used in the treatment of respiratory disease.

Key Words: cigarette smoking • asthma • COPD • idiopathic pulmonary fibrosis • corticosteroids • leukotriene receptor antagonists • theophylline • antibiotics

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