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BACKGROUND: This study aims to address this knowledge gap through comprehensive assessment of clinical and functional changes in asthma patients using various nicotine consumption methods. AIM: To evaluate the impact of different types of smoking devices (conventional cigarettes, ENDS, HTPs) on asthma course and control, lung function, quality of life, and inflammatory profile in patients aged 18–45 years. METHODS: An open observational study was conducted at Moscow City Clinical Hospital No. 24. Inclusion criteria: age 18–45 years, asthma diagnosis duration ≥12 months. Exclusion criteria: acute respiratory viral infection, pregnancy, chronic obstructive pulmonary disease, other lung diseases. Primary endpoints: asthma control (ACT questionnaire), quality of life (AQLQ questionnaire), forced expiratory volume in 1 second (FEV₁), inflammatory biomarkers (blood eosinophils, eosinophil cationic protein (ECP), periostin, thymic stromal lymphopoietin (TSLP), interleukin-13 (IL-13)). Assessment methods included validated questionnaires, spirometry, fractional exhaled nitric oxide (FeNO) measurement, and laboratory blood analysis. RESULTS: The study included 153 patients (149 men, 4 women), mean age 22.14±3.09 years. Among them, 59 were non-smokers and 94 were smokers, with 56.4% of smokers being multi-users of various smoking devices. Smoking patients had worse asthma control by 2.7 points on the ACT scale (p0.001), FEV₁ lower by 4.5% (p0.05), and quality of life by AQLQ questionnaire lower by 0.83 points (p0.001) compared to non-smokers. A change in inflammatory phenotype was identified: ECP level was 18.3% lower (p0.05), blood eosinophils 10.3% lower, neutrophil level 14.3% higher (p0.01) in smokers. Elevated levels of periostin by 31.0% (p0.05) and TSLP by 73.5% (p0.05) were observed in smoking patients. Subgroup analysis by smoking device type (conventional cigarettes, ENDS, HTPs, their combinations) revealed no statistically significant differences (p0.05). CONCLUSION: All types of smoking devices have comparable negative effects on asthma control, lung function, and patients' quality of life, and lead to changes in inflammatory phenotype with reduced eosinophilic and enhanced neutrophilic components.