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Background: Difficult asthmatics with a history of smoking, experience increased lung reactivity. Associations between related comorbidities need further investigation. Aim: To evaluate the symptoms of difficult asthmatics in relation to smoking status, in the Wessex AsThma Cohort of difficult asthma (WATCH) Southampton, UK. Methods: The smoking status of 377 adult asthmatics in WATCH was assessed for asthma control, symptoms of hyperventilation and depression. A retrospective analysis compared smoking status of difficult asthmatics using Chi square (categorical data) and Kruskall-Wallis (continuous data). Results: 180 (48%) had a history of smoking, of whom 13 continued to smoke. Differences in smoking status were not associated with BMI, but did differ by sex, age and age at diagnosis. Asthma control and symptoms of hyperventilation in ex-smokers was comparable to that of never smokers. Current smoking was associated with increased symptoms of depression and decreased attentional control than ever smokers. Conclusion: Prevalence of smoking in difficult asthma is low, but is associated with lack of asthma and attentional control, hyperventilation and depression. These findings highlight the benefits of smoking cessation.

Background: Difficult asthma is associated with increased prevalence of gastro-oesophageal reflux disease (GORD). However, it is unclear how controlling comorbid GORD impacts difficult asthma. Aim: To evaluate the impact of effectively controlling GORD symptoms in difficult asthmatics in the Wessex AsThma Cohort of difficult asthma (WATCH) Southampton UK. Methods: A retrospective analysis was undertaken to compare the reported symptoms of GORD in 311 adult asthmatics on treatment for GORD. We compared patients with ongoing GORD symptoms against those with no symptoms using Chi square (categorical data) and Mann-Whitney U tests (continuous data). Results: 208 (67%) difficult asthmatics had GORD, of whom 175 were receiving treatment for GORD. Prevalence of symptomatic GORD in those having treatment did not differ by sex, but was associated with higher BMI, worse asthma control and symptoms of depression, rhinitis and cough. Conclusion: Inadequately controlled GORD in difficult asthma is associated with increased symptoms of asthma, and related comorbidities. This highlights multiple potential benefits of optimising GORD treatment in difficult asthmatics.