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

Research output: Contribution to journalReview article

Abstract

Inflammation is a key pathology in asthma. In the central airways local inflammation leads to irreversible remodeling and airway dysfunction. Complex inflammatory changes also occur in the nose, sinuses, and small airways. In particular, rhinitis and asthma are linked by a common pathogenic process with common inflammatory cells, mediators, and cytokines. Cross-communication between the airways and bone marrow through inflammatory mediators in the circulation leads to systemic propagation of airway inflammation. Treatment of asthma has traditionally focused on relieving bronchospasm with beta(2)-agonists, which do not affect inflammation. Treatment of eosinophilic inflammation in the central airways with inhaled corticosteroids reduces local inflammation and improves pulmonary function but does not improve the systemic manifestations of asthma. If asthma is a systemic disease, the underlying systemic pathology should be targeted by identifying common disease mediators, mechanisms, or both that are triggered only during active disease. Of currently available therapies, leukotriene receptor antagonists block the action of cysteinyl leukotrienes and thus improve both asthma and rhinitis and other conditions systemically linked with asthma. Other potential treatments include receptor-blocking molecules and synthesis inhibitors related to eicosanoid inflammation. Treatment of asthma as a systemic disease requires clinical trials that evaluate the effects of new treatments on both lung function and the wider systemic pathology.

Details

Authors
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Respiratory Medicine and Allergy

Keywords

  • anti-IgE, atopic dermatitis, asthma, beta(2)-agonist, eosinophilic inflammation, inflammatory mediators, inhaled corticosteroids, rhinitis, leukotriene receptor antagonist, systemic inflammation, small airways, shift, paradigm, anti-inflammatory effects
Original languageEnglish
Pages (from-to)1269-1275
JournalJournal of Allergy and Clinical Immunology
Volume120
Issue number6
Publication statusPublished - 2007
Publication categoryResearch
Peer-reviewedYes