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Exacerbation-Prone Asthma: A Biological Phenotype or a Social Construct
Monica J Federico1, Loren C Denlinger2, Jonathan Corren3
1The Breathing Institute, Children's Hospital Colorado, and Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo.
Summary
Asthma exacerbations are driven by a combination of intrinsic biological risks and external environmental exposures. Understanding these factors is key to managing exacerbation-prone asthma (EPA) and reducing healthcare costs.
Area of Science:
- Pulmonology
- Immunology
- Environmental Health
Background:
- Asthma is a complex respiratory syndrome with diverse phenotypes and endotypes.
- Asthma exacerbations significantly contribute to morbidity, mortality, and healthcare costs.
- Recurrent exacerbations define exacerbation-prone asthma (EPA), a condition with multifactorial etiology.
Purpose of the Study:
- To characterize the intrinsic and extrinsic factors contributing to exacerbation-prone asthma (EPA).
- To explore the interplay between biological predisposition and environmental exposures in driving EPA.
- To identify key risk factors for managing and potentially preventing severe asthma exacerbations.
Main Methods:
- Review of intrinsic risk factors, including genetic and inflammatory biomarkers.
- Analysis of external factors such as viral infections, environmental pollutants, and psychosocial barriers.
- Conceptual framework integrating biological risk with the 'exposome' concept.
Main Results:
- EPA results from a combination of underlying biological susceptibility and environmental exposures.
- Intrinsic factors involve genetic and inflammatory biomarkers.
- Extrinsic factors encompass infections, pollution, allergens, and socioeconomic barriers.
Conclusions:
- Exacerbation-prone asthma (EPA) arises from the interaction between an individual's intrinsic biological risk and their environmental exposures (exposome).
- The social context and underlying biology are critical drivers of the EPA phenotype.
- Further research into these combined factors is essential for effective asthma management and prevention strategies.
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