New insights into the pathophysiology of the small airways in asthma

Abstract

Asthma is a lung disease characterized by inflammation and remodeling of the airways, which leads to airflow obstruction and symptoms of wheeze, chest tightness, cough and dyspnea. It is now widely accepted that airway inflammation and remodeling occur not only in the central airways but also in the small airways and even in the lung parenchyma. Inflammation of the distal lung can be observed even in mild asthmatics with normal or noncompromised lung function. Moreover, the small airways and the lung parenchyma can produce many Th2 cytokines and chemokines involved in initiation and perpetuation of the inflammatory process. In addition, the distal parts of the lung have been recognized as a predominant site of airflow obstruction in asthmatics. In fact, the inflammation at this distal site has been described as more severe when compared to the large airway inflammation, and evidence of remodeling in the lung periphery is emerging. Recognition of asthma as a disease of the entire respiratory tract has an important clinical significance, highlighting the need to also consider the distal lung as a target in any therapeutic strategy for effective treatment of this disease.

Mast cell–associated alveolar inflammation in patients with atopic uncontrolled asthma

“…11,52 ICSs, which are the foundation treatment of choice for patients with asthma, 6,53,54 were originally developed to treat primarily the central airways. Anti-IgE therapy (omalizumab; Xolair) was developed on the basis of the proposed IgE-driven allergic inflammation in the conducting airways.…”

An example of using a decision making framework designed for non-medical prescribers as a method for enhancing prescribing safety for inhaled corticosteroids (ICS)

“…According to a local report in Saudi Arabia, the incidents of asthma are increasing (Abudahish and Bella, 2006) affecting more than two million Saudis (AlFrayh et al, 2001). The complexity of asthma pathophysiology lies within the causes of the airway hyper-responsiveness and inflammation (Hamid and Tulic, 2007). In asthmatic attack, the stimulation of mast cells, neutrophils, eosinophils and T lymphocytes and other immune cells, will aggravate the inflammation process (Miner and Yamamoto, 1991) especially type 2 T-helper cells (Th2) which will activate the production of many mediators such as the interleukins (IL) IL-3, IL-4, IL-5, IL-13 among which some of them are related to the production of immunoglobulin E (IgE) while others cause eosinophilic inflammation (Schu¨le and Evans, 1991).…”

Effects of inhaled fluticasone on intraocular pressure and central corneal thickness in asthmatic children without a family history of glaucoma

“…Asthma is a complex syndrome characterized by airway hyper-responsiveness (AH) caused by a multi-cellular inflammatory reaction that leads to airway obstruction 12. The prevalence of asthma in Saudi Arabia has been increasing,3 and was reported to have affected 2 million individuals of Saudi Arabian origin in 2001 4.…”