Neutrophilic and Pauci-immune Phenotypes in Severe Asthma

Panettieri, Reynold A.

doi:10.1016/j.iac.2016.03.007

Cited by 48 publications

(34 citation statements)

References 60 publications

(74 reference statements)

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“…14.8%) had an ACT score of ≤19 leading to the conclusion that their asthma was not well controlled despite the absence of inflammatory cells in their induced sputum. This observation is in accordance with the hypothesis that in some cases, paucigranulocytic asthma may involve intrinsic alteration in structural cell function (such as epithelial, smooth muscle cells, vessels and nerves), which might orchestrate airway inflammation . These patients may present steroid insensitivity and therefore the use of high‐dose ICS will not provide any additional benefit in their management.…”

Section: Discussionsupporting

confidence: 87%

Clinical, functional and inflammatory characteristics in patients with paucigranulocytic stable asthma: Comparison with different sputum phenotypes

Ntontsi

Loukides

Bakakos

et al. 2017

Allergy

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Section: Discussionsupporting

confidence: 87%

Clinical, functional and inflammatory characteristics in patients with paucigranulocytic stable asthma: Comparison with different sputum phenotypes

Ntontsi

Loukides

Bakakos

et al. 2017

Allergy

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“…Elevations in sputum neutrophils are common in severe asthma and neutrophils are proposed to contribute to the etiology of the disease in some severe asthmatics (46, 47). Several clinical studies have evaluated airway inflammation in the setting of severe or uncontrolled asthma with obesity.…”

Section: Obesity Increases the Severity Of Asthmamentioning

confidence: 99%

Obesity and severe asthma

Tashiro

Shore

2019

Allergology International

100

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Obesity is an important global health issue for both children and adults. Obesity increases the prevalence and incidence of asthma and also increases the risk for severe asthma. Here we describe the features of severe asthma phenotypes for which obesity is a defining characteristic, including steroid resistance, airway inflammation, and co-morbidities. We also review current concepts regarding the mechanistic basis for the impact of obesity in severe asthma, including possible roles for vitamin D deficiency, systemic inflammation, and the microbiome. Finally, we describe data indicating a role for diet, weight loss, and exercise in the treatment of severe asthma with obesity. Better understanding of the mechanistic basis for the role of obesity in severe asthma could lead to new therapeutic options for this population.

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“…Human neutrophil lipocalin, 30 leukotriene B 4 (LTB 4 ), tumor necrosis factor-alpha (TNF-α), IL-17A, IL-8, elastase, granulocyte-macrophage-colony-stimulating factor, or MMP-9 levels are detectable in sputum, BAL fluid, and plasma in patients with severe neutrophilic asthma. 31 The raised concentrations in sputum of hydrogen sulfide could be used as a potential biomarker for neutrophilic asthma associated with airflow obstruction. 32 IL-8 activates neutrophils and sputum IL-8 levels were higher in NEA patients while IL-8 receptors are increased in this type of asthmatics.…”

Section: Diagnosis Of Neamentioning

confidence: 99%

Non-eosinophilic asthma: current perspectives

Esteban-Gorgojo¹,

Antolín‐Amérigo

Domínguez‐Ortega

et al. 2018

JAA

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Although non-eosinophilic asthma (NEA) is not the best known and most prevalent asthma phenotype, its importance cannot be underestimated. NEA is characterized by airway inflammation with the absence of eosinophils, subsequent to activation of non-predominant type 2 immunologic pathways. This phenotype, which possibly includes several not well-defined subphenotypes, is defined by an eosinophil count <2% in sputum. NEA has been associated with environmental and/or host factors, such as smoking cigarettes, pollution, work-related agents, infections, and obesity. These risk factors, alone or in conjunction, can activate specific cellular and molecular pathways leading to non-type 2 inflammation. The most relevant clinical trait of NEA is its poor response to standard asthma treatments, especially to inhaled corticosteroids, leading to a higher severity of disease and to difficult-to-control asthma. Indeed, NEA constitutes about 50% of severe asthma cases. Since most current and forthcoming biologic therapies specifically target type 2 asthma phenotypes, such as uncontrolled severe eosinophilic or allergic asthma, there is a dramatic lack of effective treatments for uncontrolled non-type 2 asthma. Research efforts are now focusing on elucidating the phenotypes underlying the non-type 2 asthma, and several studies are being conducted with new drugs and biologics aiming to develop effective strategies for this type of asthma, and various immunologic pathways are being scrutinized to optimize efficacy and to abolish possible adverse effects.

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Neutrophilic and Pauci-immune Phenotypes in Severe Asthma

Cited by 48 publications

References 60 publications

Clinical, functional and inflammatory characteristics in patients with paucigranulocytic stable asthma: Comparison with different sputum phenotypes

Clinical, functional and inflammatory characteristics in patients with paucigranulocytic stable asthma: Comparison with different sputum phenotypes

Obesity and severe asthma

Non-eosinophilic asthma: current perspectives

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