Asthma and Smoking: What's the Deal?
I was 18 years old. At the end of one of my doctor appointments, my asthma doctor started for the door, stopped, and turned around in Colombo-like fashion and said, “Oh! And one more thing.” He paused, perhaps for effect, then said. “If you should ever decide to smoke cigarettes, let me know and I’ll do you a favor and put you out of your misery.”
It was his way of reminding me that I best not smoke. His words were well received, even though I was already well aware that I should never smoke, considering I had had been dealing with severe asthma my entire life.
Smoking used to be recommended for asthma
Tobacco smoke was sometimes a remedy for asthma, but more than likely it was "asthma cigarettes," which contained belladonna and stramonium.1 I think it was Francis Rackeman (1877-1973) who once quipped that he could always tell which homes belonged to asthmatics by the sweet aroma of asthma cigarettes.
By the time I was born, the dangers of smoking were well known. In fact, thanks to the evolution of better and safer asthma medicines, smoking is no longer recommended for asthma. This is despite evidence that smoking does produce a mild bronchodilator effect. However, most health experts would agree that the risks of smoking far outweigh any benefits.
Research on smoking and asthma
Back then, the mechanisms for how smoking made asthma worse were unknown, and that basically remains the case today. However, thanks to extensive research in this regard, researchers do know a little bit more than back then.
Underlying inflammation is a hallmark of asthma
For instance, they understand that asthmatics have some degree of underlying airway inflammation that makes their airways hypersensitive (twitchy) when exposed to asthma triggers, causing asthma attacks. They also know that asthma attacks are completely reversible with either time or treatment.2,3
The inflammation present in most asthmatics is eosinophilic inflammation, and this is very responsive to corticosteroids. This is why most asthmatics respond well to inhaled corticosteroids and are able to obtain ideal asthma control.2,3
Chemicals in smoke contribute to inflammation
However, the chemicals in cigarette smoke may irritate asthmatic airways in such a way as to cause neutrophilic inflammation to exist alongside eosinophilic inflammation. Neutrophilic inflammation responds poorly or not at all to corticosteroids. So, smoking can make your lungs less responsive to traditional asthma medicine.2,3
Smoking can cause irreversible damage
Perhaps because it is not treatable, airway inflammation becomes severe, and this may cause scarring. Scarred tissue is thicker than normal, and this can lead to some degree of chronic (it’s always there) airway narrowing. This means that their asthma becomes only partially reversible with time or treatment, meaning some degree of shortness of breath is always present.4,5
So, if you already have asthma, smoking cigarettes on a daily basis long-term can cause your asthma to get worse over time, and it can also cause airway changes that may cause COPD. The combination of both asthma and COPD is generally referred to as asthma/COPD overlap syndrome.4,5
It is generally understood that asthmatics have the same life expectancy as non-asthmatics. COPD, on the other hand, is only partially reversible and progresses with age. However, aggressive treatment can slow the progression so you can live longer and better with it.4,5
COPD can develop in many ways
Now, it should be noted that you can develop COPD without smoking. You can develop it due to chronic (day after day) exposure to chemicals at your work. It can also be caused by a rare gene called alpha 1 antitrypsin. So, you don’t necessarily have to smoke to get it. However, it is also known that about 80% of people who develop COPD smoked at some point in their lifetimes.4,5
And it's also true that not everyone who smokes develops COPD. Most studies show that about 20-30% of smokers will eventually be diagnosed with it, although I have seen studies showing it's as high as 50%. Studies show that children with persistent asthma have a 32% greater risk of developing COPD, and adults with asthma have a 12% greater risk of developing it.4,5
So, with an increased risk already, smoking with asthma can only elevate the risk.
Researchers are not sure why asthmatics have an elevated risk for developing COPD, although some studies seem to suggest that asthma genes may have something to do with it. Smoking may turn some of these asthma genes into COPD genes.2,3
My thoughts on asthma and smoking
I do know some people who have asthma who also smoke. One of my friends said she thought it was fine to do because she no longer has asthma. However, I humbly reminded her that it’s a myth that asthma goes away with age, and that, even though she displays no symptoms, she still has it. “So, be warned,” I said.
And I don’t judge people. That’s not the point here. It’s a free country, so I’m not an advocate of laws forcing people to not do something they choose to do. A am, however, of the belief that education is important. Plus, I think I’d feel guilty if my friend with asthma who smokes actually developed worsening asthma or COPD and I never said anything. So, I did. And I won’t say anything further.
Okay, so, it has been known for years now that smoking can make your asthma worse. My doctor warned me not to do it. So, here’s my humble reminder to all my fellow asthmatics not to smoke, and if you do smoke, and if you're interested, here’s your incentive to quit. If you’re a former smoker, I commend you for quitting.
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