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Secretory hyperresponsiveness and pulmonary mucus hypersecretion.

Bruce K Rubin1, Kostas N Priftis2, H Joel Schmidt1

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Secretory hyperresponsiveness, distinct from airway constriction, involves excessive mucus secretion. Recognizing this condition may improve treatments for asthma, lung cancer, and plastic bronchitis.

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Bronchial hyperresponsiveness typically refers to exaggerated airway smooth muscle contraction.
  • The airway also exhibits increased mucus secretion in response to inflammation or bronchoprovocation.
  • This mucus hypersecretion is distinct from retained phlegm or sputum.

Purpose of the Study:

  • To define and introduce the term "secretory hyperresponsiveness" for increased mucus secretion.
  • To differentiate secretory hyperresponsiveness from bronchoconstrictor hyperresponsiveness.
  • To highlight its clinical relevance in various respiratory diseases.

Main Methods:

  • Conceptual definition and clinical observation.
  • Distinguishing mucus secretion from smooth muscle contraction.
  • Identifying associated molecular pathways.

Main Results:

  • Secretory hyperresponsiveness involves mucus hypersecretion, causing slowly reversible airflow limitation.
  • Conditions like middle lobe syndrome, cough-variant asthma, severe asthma, and bronchorrhea-associated lung cancer exhibit this response.
  • Extreme cases can lead to plastic bronchitis with mucus casts.

Conclusions:

  • Secretory hyperresponsiveness is a distinct clinical entity.
  • It is linked to molecular pathways involving ERK1/2, EGFR, and secretory PLA2.
  • Recognition of this phenomenon may enable targeted therapies for associated diseases.