CSB601 Chap.9 Asthma and Smoking Cessation
Asthma and Smoking Cessation
Asthma as inflammation
Week 7 treats asthma as chronic airway inflammation rather than episodic bronchospasm. For adults and adolescents, current Australian guidance places an inhaled corticosteroid in every regimen: as-needed budesonide-formoterol as the anti-inflammatory reliever, maintenance-and-reliever therapy as the step up, then add-on options or specialist referral.
Before any step up, technique, adherence, triggers and diagnosis are checked.
Nicotine dependence as a relapsing condition
Smoking cessation combines medicines that ease withdrawal or blunt reward, including nicotine replacement, varenicline and bupropion, with behavioural support that targets the routines and emotions tied to each cigarette.
What this chapter covers
- 01
Inflammatory Model of Asthma
- 02
Reliever Overuse and Its Risks
- 03
AIR and MART Strategies
- 04
Control Assessment Before Step Up
- 05
Nicotine Replacement Combinations
- 06
Varenicline, Bupropion and Behaviour Support
Worked example · free
Frequent flare-ups on a fixed-dose combination
- 2Check basics first: observe inhaler technique, ask how doses are actually taken, and look for SABA overuse, triggers, comorbidities and a possibly incorrect diagnosis.
- 2Interpret: recent severe flare-ups are a risk factor that supports moving to maintenance-and-reliever therapy with a single ICS-formoterol inhaler.
- 2Justify: MART reduces exacerbation risk relative to a twice-daily ICS-LABA combination with a separate SABA, simplifies the regimen and supports adherence; provide a written action plan.
Key terms
- Anti-Inflammatory Reliever
- As-needed low-dose budesonide-formoterol that relieves symptoms while treating airway inflammation, the preferred starting strategy for most adults and adolescents.
- Maintenance and Reliever Therapy
- A regimen in which one ICS-formoterol inhaler is taken daily for control and also as needed for relief.
- Airway Hyperresponsiveness
- An exaggerated narrowing of the airways in response to triggers, driven by persistent inflammation.
- Partial Nicotinic Agonist
- A drug such as varenicline that weakly stimulates nicotinic receptors while blocking nicotine from binding.
- Combination NRT
- Nicotine replacement that pairs a patch for steady levels with a faster form for breakthrough cravings.
Asthma and Smoking Cessation FAQ
Why is salbutamol alone no longer recommended for adults with mild asthma?
A short-acting beta2 agonist relieves bronchospasm but leaves the inflammation untreated, and reliance on it alone is associated with more severe exacerbations, admissions and deaths. Guidance therefore includes an inhaled corticosteroid from the outset, most often through as-needed budesonide-formoterol.
That combination gives fast bronchodilation from formoterol and anti-inflammatory treatment from budesonide every time symptoms prompt a dose.
Does doubling the inhaled corticosteroid dose double the benefit?
No. The dose response flattens quickly: a low dose already captures the large majority of the benefit, and each increase gives diminishing returns while systemic effects grow. Lecture material advises optimising adherence, inhaler technique and the overall strategy, and avoiding unnecessary high doses when stepping up.
When should varenicline or bupropion be started relative to the quit date?
Both are started ahead of quitting: varenicline at least one week before and bupropion at least seven days before. Varenicline commonly causes nausea and vivid dreams, and bupropion is contraindicated in seizure and eating disorders. Varenicline users should also be monitored for mood or behavioural changes, and either medicine works best with behavioural counselling.
Why do quit attempts fail even with nicotine replacement?
Smoking is tied to routines, emotions and social settings as well as nicotine levels. Without counselling, trigger identification, coping strategies and relapse planning, cravings linked to habits such as meals or coffee keep pulling the person back. Combination replacement also matters: a patch alone may leave breakthrough cravings uncovered, whereas adding a faster form handles them.
Exam move
Draw the asthma ladder from memory each day this week, from the retired reliever-only approach up through as-needed budesonide-formoterol, maintenance-and-reliever therapy and add-on options, and write the pre-step-up checks beside it. Learn the control thresholds as numbers you can quote: symptom days per week, reliever use per week, night waking and activity limitation.
For every drug class, pair one mechanism with one practice point, such as LABA always with an ICS. For smoking cessation, make a comparison of patches, faster nicotine forms, varenicline and bupropion with timing and cautions, then practise explaining why combination replacement beats a single form.
Close each session with a short case that mixes asthma and smoking, and answer it in a fixed order: control status, usage checks, regimen change, cessation plan and behavioural support.
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