Leonie Biener MD , Slagjana Stoshikj MD , Jonas Brugger MSc , Christoph Krall MSc , Roland Buhl MD , Eckard Hamelmann MD , Stephanie Korn MD , Christian Taube MD , Katring Milger MD , Christian Schulz MD , Hendrik Suhling MD , Margret Jandl MD , Rainer Ehmann MD , Olaf Schmidt MD , Marco Idzko MD , Dirk Skowasch MD , GAN Study Group
{"title":"吸烟史对德国哮喘网（GAN）中严重哮喘患者基线特征的影响。","authors":"Leonie Biener MD , Slagjana Stoshikj MD , Jonas Brugger MSc , Christoph Krall MSc , Roland Buhl MD , Eckard Hamelmann MD , Stephanie Korn MD , Christian Taube MD , Katring Milger MD , Christian Schulz MD , Hendrik Suhling MD , Margret Jandl MD , Rainer Ehmann MD , Olaf Schmidt MD , Marco Idzko MD , Dirk Skowasch MD , GAN Study Group","doi":"10.1016/j.jaip.2025.01.024","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Patients with asthma 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.</div></div><div><h3>Objective</h3><div>To evaluate the impact of cumulative smoking history on the characteristics of patients with severe asthma.</div></div><div><h3>Methods</h3><div>We analyzed pulmonary function tests, asthma control, exacerbation rate, and biomarkers. We compared active and ex-smokers (=ever-smokers) versus never-smokers and performed linear models for 3 groups stratified by smoking history (<10 pack-years [py], 10-20 py, and >20 py). Data were obtained from the severe asthma registry German Asthma Net.</div></div><div><h3>Results</h3><div>We included 2478 patients: 65 (2.6%) active smokers, 1005 (40.6%) ex-smokers, and 1408 (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: Asthma Control Test –1.76 [–2.76; –0.77] points [<em>P</em> < .001]; mini–Asthma Quality of Life Questionnaire –0.31 [–0.53; –0.10] points [<em>P</em> = .004]), whereas exacerbation rate and maintenance oral corticosteroid (OCS) doses were similar (<em>P</em> = .13 and <em>P</em> = 1.0). Cumulative smoking history was associated with smoking-related lung injury, for example, diffusing capacity for carbon monoxide (–0.37 mmol/min/kPa for 10-20 py [<em>P</em> = .014], respectively, –0.92 for >20 py [<em>P</em> < .001]), but forced expiratory volume in 1 second (FEV1) and FEV1 reversibility were similar. Cumulative smoking history was furthermore associated with 0.84 [0.73; 0.97]-fold lower fractional exhaled nitric oxide (FeNO) concentrations (<em>P</em> = .007), whereas blood eosinophil count and IgE levels were comparable (BEC: <em>P</em> = 1.0 and IgE: <em>P</em> = .49).</div></div><div><h3>Conclusions</h3><div>Cumulative smoking history in patients with asthma is associated with worse disease control, lower FeNO levels, and smoking-related lung injuries. Despite these differences, key asthma characteristics such as BEC, IgE, OCS dose, and exacerbation rates remain similar. If thoroughly examined and selected, patients with >10 py may also qualify for targeted treatments.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 5","pages":"Pages 1139-1153.e1"},"PeriodicalIF":6.6000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Impact of Smoking History on Baseline Characteristic in Patients With Severe Asthma in the German Asthma Net (GAN)\",\"authors\":\"Leonie Biener MD , Slagjana Stoshikj MD , Jonas Brugger MSc , Christoph Krall MSc , Roland Buhl MD , Eckard Hamelmann MD , Stephanie Korn MD , Christian Taube MD , Katring Milger MD , Christian Schulz MD , Hendrik Suhling MD , Margret Jandl MD , Rainer Ehmann MD , Olaf Schmidt MD , Marco Idzko MD , Dirk Skowasch MD , GAN Study Group\",\"doi\":\"10.1016/j.jaip.2025.01.024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Patients with asthma 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.</div></div><div><h3>Objective</h3><div>To evaluate the impact of cumulative smoking history on the characteristics of patients with severe asthma.</div></div><div><h3>Methods</h3><div>We analyzed pulmonary function tests, asthma control, exacerbation rate, and biomarkers. We compared active and ex-smokers (=ever-smokers) versus never-smokers and performed linear models for 3 groups stratified by smoking history (<10 pack-years [py], 10-20 py, and >20 py). Data were obtained from the severe asthma registry German Asthma Net.</div></div><div><h3>Results</h3><div>We included 2478 patients: 65 (2.6%) active smokers, 1005 (40.6%) ex-smokers, and 1408 (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: Asthma Control Test –1.76 [–2.76; –0.77] points [<em>P</em> < .001]; mini–Asthma Quality of Life Questionnaire –0.31 [–0.53; –0.10] points [<em>P</em> = .004]), whereas exacerbation rate and maintenance oral corticosteroid (OCS) doses were similar (<em>P</em> = .13 and <em>P</em> = 1.0). Cumulative smoking history was associated with smoking-related lung injury, for example, diffusing capacity for carbon monoxide (–0.37 mmol/min/kPa for 10-20 py [<em>P</em> = .014], respectively, –0.92 for >20 py [<em>P</em> < .001]), but forced expiratory volume in 1 second (FEV1) and FEV1 reversibility were similar. Cumulative smoking history was furthermore associated with 0.84 [0.73; 0.97]-fold lower fractional exhaled nitric oxide (FeNO) concentrations (<em>P</em> = .007), whereas blood eosinophil count and IgE levels were comparable (BEC: <em>P</em> = 1.0 and IgE: <em>P</em> = .49).</div></div><div><h3>Conclusions</h3><div>Cumulative smoking history in patients with asthma is associated with worse disease control, lower FeNO levels, and smoking-related lung injuries. Despite these differences, key asthma characteristics such as BEC, IgE, OCS dose, and exacerbation rates remain similar. If thoroughly examined and selected, patients with >10 py may also qualify for targeted treatments.</div></div>\",\"PeriodicalId\":51323,\"journal\":{\"name\":\"Journal of Allergy and Clinical Immunology-In Practice\",\"volume\":\"13 5\",\"pages\":\"Pages 1139-1153.e1\"},\"PeriodicalIF\":6.6000,\"publicationDate\":\"2025-05-01\",\"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://www.sciencedirect.com/science/article/pii/S2213219825001011\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/1 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ALLERGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Allergy and Clinical Immunology-In Practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213219825001011","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/1 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}
The Impact of Smoking History on Baseline Characteristic in Patients With Severe Asthma in the German Asthma Net (GAN)
Background
Patients with asthma 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 the characteristics of patients with severe asthma.
Methods
We analyzed pulmonary function tests, asthma control, exacerbation rate, and biomarkers. We compared active and ex-smokers (=ever-smokers) versus never-smokers and performed linear models for 3 groups stratified by smoking history (<10 pack-years [py], 10-20 py, and >20 py). Data were obtained from the severe asthma registry German Asthma Net.
Results
We included 2478 patients: 65 (2.6%) active smokers, 1005 (40.6%) ex-smokers, and 1408 (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: Asthma Control Test –1.76 [–2.76; –0.77] points [P < .001]; mini–Asthma Quality of Life Questionnaire –0.31 [–0.53; –0.10] points [P = .004]), whereas 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, for example, diffusing capacity for carbon monoxide (–0.37 mmol/min/kPa for 10-20 py [P = .014], respectively, –0.92 for >20 py [P < .001]), but forced expiratory volume in 1 second (FEV1) and FEV1 reversibility were similar. Cumulative smoking history was furthermore associated with 0.84 [0.73; 0.97]-fold lower fractional exhaled nitric oxide (FeNO) concentrations (P = .007), whereas blood eosinophil count and IgE levels were comparable (BEC: P = 1.0 and IgE: P = .49).
Conclusions
Cumulative smoking history in patients with asthma is associated with worse disease control, lower FeNO levels, and smoking-related lung injuries. Despite these differences, key asthma characteristics such as BEC, IgE, OCS dose, and exacerbation rates remain similar. If thoroughly examined and selected, patients with >10 py may also qualify for targeted treatments.
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.
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