Time for a paradigm shift in asthma treatment: From relieving bronchospasm to controlling systemic inflammation

Bjermer, Leif

doi:10.1016/j.jaci.2007.09.017

Cited by 75 publications

(71 citation statements)

References 69 publications

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“…Therefore, multiple studies have been performed to establish further inflammatory markers for equine respiratory disease. Evidence exists that systemic involvement may exist in RAO as has been shown for human Asthma bronchiale (Bjermer 2007) and Chronic obstructive pulmonary disease (COPD, Rosenberg und Kalha 2012, Koutsokera et al 2012). Therefore, not only markers for pulmonary inflammation dominated by neutrophils, but also systemic markers in peripheral blood may be rewarding in the evaluation of equine disease.…”

Section: Introductionmentioning

confidence: 92%

“…During disease exacerbation, peripheral blood leucocyte activation and increased concentration of circulatory inflammatory mediators have been observed in affected horses, suggesting that the inflammatory process might not be limited to the lung , Rickards et al 2004, Marr et al 2002, Kirschvink et al 2002, Gray et al 1989. Human asthma, which shares many pathophysiological features with equine RAO, is considered to be a systemic disease, as an increase in several inflammatory markers has been observed in the blood of affected patients (Bjermer 2007). These include immunity-related mediators (cytokines, eicosanoids, cyclooxygenase products and IgEs) and the acute phase markers C-reactive protein, haptoglobin, fibrinogen and serumamyloid A (Kasayama et al 2009, Wu et al 2007, Koh et al 1996.…”

Section: Systemic Inflammatory Markers In the Bloodmentioning

confidence: 99%

“…These include immunity-related mediators (cytokines, eicosanoids, cyclooxygenase products and IgEs) and the acute phase markers C-reactive protein, haptoglobin, fibrinogen and serumamyloid A (Kasayama et al 2009, Wu et al 2007, Koh et al 1996. Systemic inflammation in patients with chronic airway diseases is thought to contribute to comorbidities (Bjermer 2007, Schanen et al 2005, Song et al 2010, Sin et al 2006, Yende et al 2006). …”

Section: Systemic Inflammatory Markers In the Bloodmentioning

confidence: 99%

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Diagnostic value of inflammatory markers in chronic respiratory disease of the horse – a review

Barton¹,

Shety²,

Wirth³

et al. 2014

PHK

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Summary: Over the last years local and systemic inflammatory markers of chronic pneumopathies have gained increasing interest in research, as the pathogenesis of Recurrent airway obstruction (RAO) and Inflammatory airway disease (IAD) remains not fully elucidated in several details. In human medicine, Asthma bronchiale and Chronic obstructive pulmonary disease (COPD) have been found to be influenced by systemic inflammatory processes and the other way around. Inflammation, coagulation and fibrinolysis as well as extracellular remodeling show close interactions. Cytology of bronchoalveolar lavage fluid and tracheal wash is commonly used to evaluate the severity of local inflammation in the lung. Interleukins involved in the chemotaxis of neutrophils like Interleukin 8, 17 and 23 have been studied. Chronic obstructive pneumopathies lead to remodeling of bronchial walls and lung parenchyma, ultimately causing fibrosis. Matrix-metalloproteinases (MMPs) are discussed as the most important proteolytic enzymes during remodeling in human medicine. In the horse, MMP 9 seems to be a central player in chronic respiratory disease as well. A systemic involvement has been shown for RAO by increased acute-phaseproteins like serumamyloid A and haptoglobin in peripheral blood during exacerbation. Studies focusing on these and further possible inflammatory markers for chronic respiratory disease in the horse are discussed in this review of literature.Keywords: Inflammatory markers / horse / respiratory disease / recurrent airway obstruction / RAO / Diagnostischer Wert verschiedener Entzündungsmarker bei chronischen Atemwegserkrankungen des Pferdes -eine ÜbersichtIn den letzten Jahren häufen sich Untersuchungen zu verschiedenen lokalen und systemischen Entzündungsmarkern bei chronischen Pneumopathien des Pferdes, da das Verständnis der Pathogenese von Recurrent airway obstruction (RAO) und Inflammatory airway disease (IAD) weiterhin nicht vollständig geklärt ist. Ein Blick in die Humanmedizin zeigt, dass das Asthma bronchiale und die Chronic obstructive pulmonary disease (COPD) durchaus in Zusammenhang stehen mit systemischen inflammatorischen Prozessen, so dass sich die lokalen Prozesse in der Lunge und systemische Entzündungsreaktionen gegenseitig beinflussen. Entzündung, Koagulation und Fibrinolyse sowie das extrazelluläre Remodelling sind eng miteinander verknüft. Zytologische Untersuchungen der bronchoalveolären Lavageflüssigkeit und des Tracheobronchialsekrets stellen die gebräuchlichste Methode dar, den Schweregrad der lokalen Entzündung zu beurteilen. Hierbei ergeben sich Zusammenhänge zu Interleukinen, die an der Chemotaxis neutrophiler Granulozyten beteiligt sind, wie beispielsweise Interleukin 8, 17 und 23. Chronisch obstruktive Pneumopathien führen langfristig zu chronischen Umbauprozessen der Bronchienwände und des Lungenparenchyms (Remodelling), die mit der Bildung von Fibrosen einhergehen. Matrix-Metalloproteinasen (MMPs) gelten in der Humanmedizin als wichtigste proteolytische Enzyme bei diesem Remodelling und auch...

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Section: Introductionmentioning

confidence: 92%

Section: Systemic Inflammatory Markers In the Bloodmentioning

confidence: 99%

Section: Systemic Inflammatory Markers In the Bloodmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic value of inflammatory markers in chronic respiratory disease of the horse – a review

Barton¹,

Shety²,

Wirth³

et al. 2014

PHK

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“…There is also mounting evidence that the inflammatory mediators from the airways are distributed systemically, resulting in far-reaching inflammatory effects in the skin, bone marrow and intestines [5]. As a result, a new appreciation of asthma as a respiratory manifestation of systemic inflammatory processes is emerging [6].…”

Section: Inflammation: a Key Pathology In Asthmamentioning

confidence: 99%

“…The increase in asthma prevalence over recent decades has been accompanied by an increase in atopic sensitisation and allergic conditions such as rhinitis and sinusitis, suggesting that there may be a systemic component to the inflammation associated with asthma [4][5][6]. Despite the increasing evidence of the systemic inflammation model and the emerging data suggesting a role for inflammation in structural remodelling of the airways [7,8], many patients remain reliant on medications that relieve symptoms or treat inflammation only within the lower airways [9,10].…”

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confidence: 99%

The Brussels Declaration: the need for change in asthma management

Holgate

Bisgaard

Bjermer

et al. 2008

European Respiratory Journal

102

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Asthma is a highly prevalent condition across Europe and numerous guidelines have been developed to optimise management. However, asthma can be neither cured nor prevented, treatment choices are limited and many patients have poorly controlled or uncontrolled asthma.The Brussels Declaration on Asthma, sponsored by The Asthma, Allergy and Inflammation Research Charity, was developed to call attention to the shortfalls in asthma management and to urge European policy makers to recognise that asthma is a public health problem that should be a political priority.The Declaration urges recognition and action on the following points: the systemic inflammatory component of asthma should be better understood and considered in assessments of treatment efficacy; current research must be communicated and responded to quickly; the European Medicines Agency guidance note on asthma should be updated; ''real world'' studies should be funded and results used to inform guidelines; variations in care across Europe should be addressed; people with asthma should participate in their own care; the impact of environmental factors should be understood; and targets should be set for improvement.The present paper reviews the evidence supporting the need for change in asthma management and summarises the ten key points contained in the Brussels Declaration.

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Association Between Asthma and Risk of Developing Obstructive Sleep Apnea

Teodorescu

Barnet

Hagen

et al. 2015

JAMA

162

102

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Importance Obstructive sleep apnea (OSA) is more common among patients with asthma; whether asthma is associated with the development of OSA is unknown. Objective To examine the prospective relationship of asthma with incident OSA. Design Population-based prospective epidemiology study (the Wisconsin Sleep Cohort). Setting Beginning in 1988, adult participants were recruited from a random sample of Wisconsin state employees to attend overnight polysomnography studies at 4-year intervals. Asthma and covariate information were assessed during polysomnography studies through March 2013. Participants Participants identified as free of OSA (apnea-hypopnea index<5 events/hr and not treated) by two baseline polysomnography studies and that had at least one additional polysomnography study were included. 547 participants (52% women; mean [SD] baseline age = 50 [8] years) provided 1105 4-year follow-up intervals. Exposure Questionnaire-assessed presence and duration of self-reported physician-diagnosed asthma. Main Outcome The associations of presence and duration of asthma with 4-year incidences of both OSA (apnea-hypopnea index ≥ 5 or positive airway pressure treatment) and OSA concomitant with habitual daytime sleepiness were estimated using repeated-measures Poisson regression, adjusting for confounders. Results Twenty-two out of 81 (27% [95% CI=17%–37%]) participants with asthma experienced incident OSA over their first observed 4-year follow-up interval compared to 75 incident cases of OSA among 466 participants without asthma (16% [95% CI, 13%–19%]). Using all 4-year intervals, participants with asthma experienced 45 incident OSA cases during 167 4-year intervals (27% [95% CI, 20%–34%]) and participants without asthma experienced 160 incident OSA cases during 938 4-year intervals (17% [95% CI, 15%–19%]); the corresponding adjusted relative risk was 1.39 (95% CI, 1.06–1.82), controlling for sex, age, baseline and change in body mass index, and other factors. Asthma was also associated with new-onset OSA with habitual sleepiness (relative risk: 2.72 [95% CI, 1.26–5.89], p=0.04). Asthma duration was related to both incident OSA (relative risk: 1.07 per 5-year increment in asthma duration [95% CI, 1.02–1.13], p=0.01) and incident OSA with habitual sleepiness (relative risk: 1.18 [95% CI, 1.07–1.31], p=0.02). Conclusions and Relevance Asthma was associated with increased risk of new-onset OSA. Studies investigating the value of periodic OSA evaluation in patients with asthma are warranted.

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Time for a paradigm shift in asthma treatment: From relieving bronchospasm to controlling systemic inflammation

Cited by 75 publications

References 69 publications

Diagnostic value of inflammatory markers in chronic respiratory disease of the horse – a review

Diagnostic value of inflammatory markers in chronic respiratory disease of the horse – a review

The Brussels Declaration: the need for change in asthma management

Association Between Asthma and Risk of Developing Obstructive Sleep Apnea

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