From the Guidelines
Biologic therapy for asthma can be used in smokers, but with caution and careful consideration of the potential reduced efficacy due to smoking-induced changes in airway inflammation patterns. Smoking may reduce the effectiveness of some biologics, particularly those targeting type 2 inflammation like omalizumab, dupilumab, mepolizumab, benralizumab, and tezepelumab 1. Smokers with asthma should be strongly encouraged to quit smoking as part of their treatment plan, as smoking worsens asthma control, accelerates lung function decline, and can diminish response to corticosteroids. For smokers who cannot quit, biologic therapy may still be beneficial if they meet other criteria for biologics, such as having severe, uncontrolled asthma despite high-dose inhaled corticosteroids and long-acting beta-agonists. The choice of biologic should be based on the patient's specific asthma phenotype and biomarkers.
Some key points to consider when using biologic therapy in smokers with asthma include:
- Biomarkers may predict responsiveness to anti-inflammatory therapies, such as a history of COPD exacerbations, circulating eosinophilia, and/or sputum eosinophilia predicts responsiveness to corticosteroids 1
- Broad-spectrum anti-inflammatory treatments seem more likely to be effective, but frequent side-effects occur when such agents are given orally 1
- Inhaled strategies, such as ICS/LABA and ICS alone, are anti-inflammatory agents and may be effective in reducing inflammation and improving symptoms 1
- The decision to use biologics in smokers should be individualized, weighing potential benefits against the possibility of reduced efficacy due to smoking-induced changes in airway inflammation patterns.
It is essential to regularly assess smoking status and offer smoking cessation support at every opportunity to improve treatment outcomes and reduce the risk of complications. By carefully considering these factors and individualizing treatment, biologic therapy can be a valuable option for smokers with asthma who meet specific criteria.
From the FDA Drug Label
The impact of longer exposure to XOLAIR or use in patients at higher risk for malignancy (e. g., elderly, current smokers) is not known. The FDA drug label does not answer the question.
From the Research
Biologic Therapy for Asthma in Smokers
- There is limited information available on the use of biologic therapy for asthma in smokers, as most studies focus on non-smoking populations or do not specify smoking status.
- A study on biologic therapy in asthma does not mention smoking status as a factor in treatment outcomes 2.
- Another study discusses the various biologic therapies available for severe asthma but does not address the issue of smoking 3.
- The clinical effects and immune modulation of biologics in asthma are discussed in a review, but it does not consider the impact of smoking on treatment outcomes 4.
- A review of biologic therapy in the management of asthma notes that some asthma is not well controlled with inhaled steroids alone, but it does not mention smoking as a factor in this lack of control 5.
- A case series on combining dual biologics therapy for severe asthma presents ten cases, but it does not provide information on the smoking status of the patients 6.
Considerations for Biologic Therapy in Smokers
- The available evidence does not provide clear guidance on the use of biologic therapy for asthma in smokers.
- More research is needed to determine the effectiveness and safety of biologic therapy for asthma in smoking populations.
- Studies that investigate the impact of smoking on biologic therapy outcomes in asthma are necessary to inform treatment decisions for smokers with asthma 2, 3, 4, 5, 6.