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PCTs ordered to use enhanced services cash on hospitals

Smokers need more aggressive symptom control, the British Thoracic Society winter meeting heard ­ by Rob Finch

GPs have been urged to consider high doses of inhaled steroids for smokers with mild asthma after new research found they were 'resistant' to the effects of treatment.

Smokers respond less well than non-smokers to drug therapy and need more aggressive symptom control, according to the study, which claimed to have 'important implications' for practice.

In the study of 95 mild asthmatics, six smokers on 400µg beclomethasone suffered exacerbations but only one non-smoker. Smokers' morning peak flow readings remained at just 25l/min after treatment, compared with 45l/min in non-smokers.

But in patients treated with high doses of inhaled steroids, there was no longer a significant difference in treatment responses.

Study leader Professor Neil Thomson, professor of respiratory medicine at the University of Glasgow, said: 'The response to therapy is not the same as one would expect in a non-smoker. At a practical level, if symptom control is not improved, use an add-on therapy.'

He added: 'The disparity of response between smokers and non-smokers is reduced with high-dose inhaled corticosteroids.'

Dr Kevin Gruffydd-Jones, a GP in Box, Wiltshire, and education lead for the General Practice Airways Group, said the findings 'ought to start to change practice'.

He added: 'This is good emerging evidence that maybe we should be using high doses in smokers.' But the optimum dose in primary care had not yet been decided, he said.

'The caution is ­ we do

not really want to be using

a high dose. Would combination therapy be any better?'

Dr Alex Bobak, chair of Smoking Cessation in Primary Care and a GP in Wands-worth, south-west London, said: 'It is much more im-

portant to concentrate on stopping them smoking than tinkering with their treat-ment.

'You can use the fact that they need more steroids or are having more exacerbations to help them stop smoking. But there is a danger of over-medicalising their condition.'

The study randomised patients to 12 weeks of 400 or 2000µg beclomethasone.

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