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Journal Article Ahead of print 1 citation

PubMed: 42773700 DOI: 10.1093/ajrccm/aamag473

Biologic outcomes in severe asthma patients by smoking status: evidence from SHARP.

Am J Respir Crit Care Med

Authors: Marco Caminati, Jeremy Charriot, Aruna T Bansal, Shane Hanon, Renaud Louis, Florence Schleich, Muriel Delvaux, Guy Brusselle, Stéphanie Ziant, Virginie Paulus, Sanja Grle Popovic, Gordana Pavlisa, Marina Lampalo, Celeste Porsbjerg, Kjell Håkansson, Susanne Hansen, Arnaud Bourdin, Eve Klising, Candice Estellat, Caroline Giboin, Dounya Metdaoui, Zsuzsanna Csoma, Dora Lúðvíksdóttir, Giorgio Walter Canonica, Enrico Heffler, Cristina Cardini, Anna Alloni, Iveta Kroica, Kristina Bieksiene, Romain Tching, Anneke Ten Brinke, Jacob Sont, Piotr Kuna, Maria Morawska, Florin Mihaltan, Sanja Hromis, Aleksa Golubovic, Mihailo Stjepanovic, Vojislav Ćupurdija, Peter Kopac, Valentyna Yasinska, Fabienne Jaun, Joerg Leuppi, Ebru Damadoglu, Ozlem Goksel, Sabina Skrgat, Ratko Djukanovic, Bilun Gemicioglu

Affiliations

  • Allergy and Clinical Immunology, Department of Medicine, University of Verona, Verona, Italy.
  • CHU Arnaud de Villeneuve - Département de Pneumologie et Addictologie, PhyMedExp, Université de Montpellier, France - https://orcid.org/0000-0002-1420-5774.
  • Acclarogen Ltd, St John's Innovation Centre Cowley Road, Cambridge, UK.
  • UZ Brussel/ Vrije Universiteit Brussel (VUB), Belgium.
  • Liege University, Liege, Belgium.
  • Respiratory Medicine, CHU of Liege, Belgium, GIGA I3, University of Liege and Exercise Physiology Lab, Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium.
  • Service de pneumologie-allergologie, Centre Hospitalier Universitaire de Liège, Belgium.
  • Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
  • University Hospital Centre Zagreb KBCZ, Clinic for Pulmonary Diseases Jordanovac, Croatia.
  • School of Medicine, University of Zagreb, Zagreb, Croatia.
  • Faculty of Health Studies, University of Rijeka.
  • Bispebjerg University Hospital, Copenhagen, Denmark.
  • PhyMedExp, INSERM, EFS, Université de Montpellier, CHU Montpellier, Montpellier, France.
  • AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, INSERM, Centre de Pharmacoépidémiologie, Paris, France.
  • Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, équipe PEPITES, AP-HP, Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephépi), Paris, France.
  • National Koranyi Institute for Pulmonology, Hungary.
  • Department of Respiratory Medicine, Landspítali University Hospital, Reykjavík, Iceland, University of Iceland.
  • Departmento of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy.
  • Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano (MI), Italy.
  • Fondazione per la Salute Respiratoria della Società Italiana di Pneumologia SIP-IRS,Milan, Italy.
  • Biomeris srl, Italy.
  • Riga East University Hospital, Latvia.
  • Department of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
  • Information Technology for Translational Medicine SA, Luxembourg.
  • Frisius Medical Center, Leeuwarden, The Netherlands.
  • Leiden University Medical Centre, Leiden, The Netherlands.
  • Medical University of Lodz, Poland.
  • National Institute of Pneumology, Romania.
  • Faculty of Medicine, University of Novi Sad, Serbia.
  • Institute for Pulmonary Diseases of Vojvodina, Serbia.
  • Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac Serbia.
  • University Hospital of Respiratory and Allergic Diseases, Golnik, Slovenia.
  • Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
  • Karolinska Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
  • University Institute of Internal Medicine, Basel, Switzerland.
  • University of Basel, Basel, Switzerland.
  • Hacettepe University, Faculty of Medicine, Department of Pulmonary Diseases, Division of Allergy and Clinical Immunology, Ankara, Türkiye, Department of Pulmonary Medicine, Immunology and Allergy. Ege University Faculty of Medicine, Izmir, Turkiye.
  • EgeSAM-Translational Pulmonary Research Center. Ege University, Izmir, Turkiye.
  • Department of Pulmonary Diseases and Allergy, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia.
  • Department of Pulmonary Diseases and Allergy, University Medical Centre Ljubljana, Slovenia;Medical Faculty, University of Ljubljana, Slovenia.
  • Southampton University Hospital, Southampton, United Kingdom.
  • Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul-Türkiye.
  • Institute of Pulmonology and Tuberculosis, Istanbul University-Cerrahpasa, Istanbul-Türkiye.

Abstract

RATIONALE

The efficacy of biologics remains debatable in current or ex- smokers with severe asthma.

OBJECTIVES

This study aimed to evaluate responses to biologics by smoking exposure and to assess variations in management practice across Europe.

METHODS

This was a retrospective real-world study of adults with severe asthma from 16 European countries assessed at baseline and after 1-year of biologic treatment. Data were collected within the ERS SHARP (Severe Heterogeneous Asthma Research-Patient Centred) registry, applying the OMOP Common Data Model.

MEASUREMENTS AND MAIN RESULTS

Of the 3,876 adult patients, 2,383 were never-smokers, 540 ex-smokers (<10 pack-years), 812 (≥10 pack-years), and 141 current-smokers. In all 4 groups, symptom control (ACT≥20/ACQ≤1.5) improved, frequent exacerbations (≥2/year) decreased, asthma quality of life (AQLQ) improved, and oral corticosteroid use decreased. While the starting point sometimes differed, the order of magnitude of change was not statistically different between groups. A country-averaged analysis of the SHARP survey revealed that 29% of participating nations reported opposition to prescribing biologics to current smokers, while 59% expressed dissatisfaction with current treatment guidelines.

CONCLUSION

Our study reveals a lower prevalence of biologic therapy among adults with severe asthma who smoke and provides evidence suggesting this practice is unwarranted. Former/current smokers who underwent biologic therapy for one year responded as effectively as never-smokers. Recognising the complexity of nicotine dependence, smoking cessation should remain a central goal in asthma management. This study underscores the need for randomized controlled trials in smokers to enable more robust and inclusive scientific conclusions and guidelines.

MeSH

Smokers, Critical Care, Smoke, Therapeutics, Asthma, Biological Therapy, Smoking