Precision medicine in asthma and chronic obstructive pulmonary disease
Debmalya Barh in Precision Medicine in Cancers and Non-Communicable Diseases, 2018
Bronchoconstriction is a characteristic symptom of COPD and asthma (Seehase et al., 2011). Erythrocyte glutathione peroxidase activity levels are elevated in the case of asthma (Tho and Candlish, 1987). IL-16 is a proinflammatory cytokine involved in the development of asthma. It is responsible for recruitment of CD4+ T cells to sites of asthma (Nicoll et al., 1999). IL-13 is a Th2 cytokine acting as an important mediator of airway inflammation and leading to asthma lesions. IL-13 can be estimated using the Erenna immunoassay system (St Ledger et al., 2009). TNFalpha and IL-13 are involved in activation of oxytocin receptors. This activity in airway smooth muscle cells is implicated in asthma development (Amrani et al., 2010). 20-HETE has been reported to play a pivotal role in mediation of acute ozone-induced airway hyperresponsiveness (AHR; Cooper et al., 2010). Phosphoinositide 3-kinase gamma (PI3Kgamma) is involved in the pathogenesis of asthma. PI3Kgamma modulates calcium oscillations and hence regulates contraction of the airway smooth muscles. PI3Kgamma inhibitors can help overcome AHR (Jiang et al., 2010). Prostaglandin D(2) is a noninvasive biomarker of asthma and it has been found to cause contractions in peripheral lung tissue (Larsson et al., 2011). Trichostatin A (TSA) is an inhibitor of histone deacetylase (HDAC), which produces an inhibitory effect on airway hyperresponsiveness (Banerjee et al., 2012).
The Relationship between the Upper and Lower Respiratory Tract
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
There are many anatomical and physiological similarities between the upper and lower airways. They are both lined by pseudostratified ciliated columnar epithelium on a continuous basement membrane (Figures 102.1a and 102.1b). Throughout the submucosa there are mucous glands, blood vessels, structural cells (fibroblasts), some inflammatory cells (monocytic cells, lymphocytes and mast cells) and nerves. There are also significant differences however, between the upper and lower respiratory tracts. The nasal mucosa is highly vascular with an extensive subepithelial capillary and arterial system and venous cavernous sinusoids. Vascular dilatation can result in increased upper airway resistance and subsequent nasal obstruction. In contrast, bronchoconstriction is due to the contraction of airway smooth muscle which is present from the trachea to the bronchioles, rather than changes in the vasculature.
Management of Adolescent Asthma
Jonathan A. Bernstein, Mark L. Levy in Clinical Asthma, 2014
Over time, adolescents develop formal operational thinking, which encompasses the skills of abstract thinking, logical reasoning, and problem solving.31 Unlike children, who cannot think beyond the observable, adolescents can think abstractly, reflect upon their thoughts, and develop solutions accordingly. The hallmarks of asthma are chronic airway inflammation and bronchoconstriction. With more sophisticated thinking, adolescents are able to understand inflammation, something that they cannot necessarily see or feel. They can also begin to link the sensation of chest tightness to the concept of airway constriction. Moreover, they can differentiate between rescue medications and daily anti-inflammatory medications, and understand the role of each. Although early adolescents may not be ready to assume responsibility for taking daily medication,30 clinicians should begin to teach them about the pathophysiology of asthma and how bronchodilators and anti-inflammatory medications work.
Development and assessment of a low literacy, pictographic asthma action plan with clinical automation to enhance guideline-concordant care for children with asthma
Published in Journal of Asthma, 2023
Patrick T. Reeves, Timothy M. Kenny, Laura T. Mulreany, Michael Y. McCown, Jane E. Jacknewitz-Woolard, Philip L. Rogers, Sofia Echelmeyer, Sebastian K. Welsh
Asthma is a serious, potentially lethal, clinical syndrome with wide-ranging phenotypes of lung reactivity and inflammation that affects approximately 300 million people worldwide (1). Asthma is distinguished by chronic airway inflammation, increased bronchoconstriction, and a history of reversible symptoms including: cough, wheezing, dyspnea, and chest tightness. Asthma frequently causes missed school and workdays lost, and is a top 10 cause of Disability adjusted Life years (DALYs) for children age 5–14 years (2,3). This represents a significant healthcare economic burden (1). Inhaled corticosteroids, long acting beta agonists (LABA), rescue Short-acting Beta-2 Agonist (SABA), and patient education initiatives have each been employed to varying degrees of success in an attempt to control symptoms and improve outcomes in patients with asthma (4–6).
Advances in phosphoproteomics and its application to COPD
Published in Expert Review of Proteomics, 2022
Xiaoyin Zeng, Yanting Lan, Jing Xiao, Longbo Hu, Long Tan, Mengdi Liang, Xufei Wang, Shaohua Lu, Tao Peng, Fei Long
Chronic obstructive pulmonary disease (COPD) is characterized by not fully reversible airflow limitation, varying with cough, phlegm, wheezing, breathlessness, and comorbidities in clinical manifestations. The typical COPD phenotype is mainly chronic airway inflammation, and emphysema type, while special patients will have a more refined inflammatory phenotype. Fibrotic lesions can be found in the small airways and can contribute to small airway obstruction in COPD [4]. This can cause difficulties in breathing and can lead to more severe symptoms of COPD. Different phenotypes of patients have different degrees of expiratory airflow limitation [5]. Asthma is characterized by airway narrowing due to bronchoconstriction and airway inflammation. Asthma may be a risk factor for COPD. In severe asthma, structural changes such as airway remodeling can lead to airway obstruction and a narrower inner diameter of the airway. Approximately 15–20% of COPD patients have features of both of these diseases [6], which is termed asthma-COPD overlap (ACO). Whether COPD, asthma, or ACO, they are all characterizes as heterogeneous diseases, which means more disease burden and challenges to current diagnostic and therapeutic strategies.
Applications of oscillometry in clinical research and practice
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Lennart K. A. Lundblad, Salman Siddiqui, Ynuk Bossé, Ronald J. Dandurand
A core element of diagnosing lung disease is establishing the presence or absence of reversibility of bronchoconstriction. This is typically done comparing lung mechanics measurement before and after bronchodilation with an inhaled drug such as albuterol or terbutaline. The reversibility of lung function is a characteristic of asthma frequently determined with spirometry as a change of FEV1 of 12% following inhalation of a bronchodilator. In a paper by Oostveen et al.88 a positive response in asthmatic patients as the 95th percentile of the bronchodilator response in healthy adults was established. The 95th percentiles for the absolute and relative changes in Rrs and Xrs at low frequencies due to bronchodilation were established. For example, the 95th percentile response in Rrs at 5 Hz was −1.37 hPa.s.L−1 (−1.40 cmH2O.s.L−1), corresponding to a relative decrease of 32%, for Xrs at 5 Hz it was 0.55 hPa.s.L−1 (0.56 cmH2O.s.L−1), corresponding to −43%, and finally AX was −3.90 hPa.s.L−1 (−3.98 cmH2O.L−1), corresponding to −65%.
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- Asthma
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