Tumor necrosis factor-alpha in severe corticosteroid-refractory asthma

Tumor necrosis factor (TNF)-alpha is a proinflammatory cytokine. Blocking TNF-alpha has been demonstrated to be effective in various diseases, including both rheumatoid and psoriatic arthritis. There is evidence to show that levels of TNF-alpha are elevated in patients with severe asthma. TNF-alpha is involved in the initiation and perpetuation of the inflammatory process, epithelial damage and remodeling, and mucin hypersecretion. Furthermore, TNF-alpha polymorphism has also been reported in the asthmatic population. Based on the necessity for alternative treatments for asthmatics with severe disease and those who are particularly resistant to conventional asthma therapy, it has been shown that molecules targeted at blocking the effects of TNF-alpha probably constitute a considerable advance in the management of these difficult patients. This review focuses on the evidence of TNF-alpha axis upregulation in severe corticosteroid-refractory asthma, as well as the role of TNF-alpha inhibition and the adverse effects of treatment.