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Pathophysiological Mechanisms of Asthma.
1Departments of Paediatrics and Paediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust and Imperial College, London, United Kingdom.
Frontiers in Pediatrics
|April 4, 2019
Summary
Asthma management can be improved by identifying treatable traits like variable airflow obstruction, inflammation, and infection using simple tests. This approach allows for targeted treatments, moving beyond a one-size-fits-all approach to asthma care.
Area of Science:
- Respiratory Medicine
- Clinical Immunology
- Pulmonology
Background:
- The term "asthma" encompasses a syndrome of respiratory symptoms.
- A comprehensive approach is needed to deconstruct airway disease components.
- Extra-pulmonary comorbidities and environmental factors influence asthma.
Purpose of the Study:
- To emphasize delineating "treatable traits" in asthma management.
- To highlight the role of non-invasive tests in diagnosing airway disease components.
- To advocate for phenotyping and endotyping for personalized asthma treatment.
Main Methods:
- Utilizing spirometry with bronchodilator reversibility testing for airflow obstruction.
- Employing peripheral blood eosinophil counts, induced sputum, and exhaled nitric oxide for airway eosinophilia.
- Conducting sputum or cough swab cultures for bacterial infection identification.
Main Results:
- Variable airflow obstruction, eosinophilic inflammation, and bacterial infection are key treatable traits.
- Simple, non-invasive tests can determine these traits.
- Fixed airflow obstruction is often untreatable and should not be over-treated.
Conclusions:
- Phenotyping airways through simple tests enables precise diagnosis and targeted asthma therapy.
- Moving towards endotyping, especially with advancements in -omics technology, is crucial for future treatments.
- Current management can be improved by considering diverse pathophysiologies and utilizing readily available diagnostic tools.
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