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Time for a paradigm shift in asthma treatment: From relieving bronchospasm to controlling systemic inflammation

Bjermer, Leif LU (2007) In Journal of Allergy and Clinical Immunology 120(6). p.1269-1275
Abstract
Inflammation is a key pathology in asthma. In the central airways local inflammation leads to irreversible remodeling and airway dysfunction. Complex inflammatory changes also occur in the nose, sinuses, and small airways. In particular, rhinitis and asthma are linked by a common pathogenic process with common inflammatory cells, mediators, and cytokines. Cross-communication between the airways and bone marrow through inflammatory mediators in the circulation leads to systemic propagation of airway inflammation. Treatment of asthma has traditionally focused on relieving bronchospasm with beta(2)-agonists, which do not affect inflammation. Treatment of eosinophilic inflammation in the central airways with inhaled corticosteroids reduces... (More)
Inflammation is a key pathology in asthma. In the central airways local inflammation leads to irreversible remodeling and airway dysfunction. Complex inflammatory changes also occur in the nose, sinuses, and small airways. In particular, rhinitis and asthma are linked by a common pathogenic process with common inflammatory cells, mediators, and cytokines. Cross-communication between the airways and bone marrow through inflammatory mediators in the circulation leads to systemic propagation of airway inflammation. Treatment of asthma has traditionally focused on relieving bronchospasm with beta(2)-agonists, which do not affect inflammation. Treatment of eosinophilic inflammation in the central airways with inhaled corticosteroids reduces local inflammation and improves pulmonary function but does not improve the systemic manifestations of asthma. If asthma is a systemic disease, the underlying systemic pathology should be targeted by identifying common disease mediators, mechanisms, or both that are triggered only during active disease. Of currently available therapies, leukotriene receptor antagonists block the action of cysteinyl leukotrienes and thus improve both asthma and rhinitis and other conditions systemically linked with asthma. Other potential treatments include receptor-blocking molecules and synthesis inhibitors related to eicosanoid inflammation. Treatment of asthma as a systemic disease requires clinical trials that evaluate the effects of new treatments on both lung function and the wider systemic pathology. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anti-IgE, atopic dermatitis, asthma, beta(2)-agonist, eosinophilic inflammation, inflammatory mediators, inhaled corticosteroids, rhinitis, leukotriene receptor antagonist, systemic inflammation, small airways, shift, paradigm, anti-inflammatory effects
in
Journal of Allergy and Clinical Immunology
volume
120
issue
6
pages
1269 - 1275
publisher
Elsevier
external identifiers
  • wos:000251653800004
  • pmid:18073122
  • scopus:36749016935
ISSN
1097-6825
DOI
10.1016/j.jaci.2007.09.017
language
English
LU publication?
yes
id
5ad76d1b-2653-4deb-aec5-80cae8012196 (old id 965907)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18073122?dopt=Abstract
date added to LUP
2008-01-29 13:33:12
date last changed
2017-10-22 03:38:17
@article{5ad76d1b-2653-4deb-aec5-80cae8012196,
  abstract     = {Inflammation is a key pathology in asthma. In the central airways local inflammation leads to irreversible remodeling and airway dysfunction. Complex inflammatory changes also occur in the nose, sinuses, and small airways. In particular, rhinitis and asthma are linked by a common pathogenic process with common inflammatory cells, mediators, and cytokines. Cross-communication between the airways and bone marrow through inflammatory mediators in the circulation leads to systemic propagation of airway inflammation. Treatment of asthma has traditionally focused on relieving bronchospasm with beta(2)-agonists, which do not affect inflammation. Treatment of eosinophilic inflammation in the central airways with inhaled corticosteroids reduces local inflammation and improves pulmonary function but does not improve the systemic manifestations of asthma. If asthma is a systemic disease, the underlying systemic pathology should be targeted by identifying common disease mediators, mechanisms, or both that are triggered only during active disease. Of currently available therapies, leukotriene receptor antagonists block the action of cysteinyl leukotrienes and thus improve both asthma and rhinitis and other conditions systemically linked with asthma. Other potential treatments include receptor-blocking molecules and synthesis inhibitors related to eicosanoid inflammation. Treatment of asthma as a systemic disease requires clinical trials that evaluate the effects of new treatments on both lung function and the wider systemic pathology.},
  author       = {Bjermer, Leif},
  issn         = {1097-6825},
  keyword      = {anti-IgE,atopic dermatitis,asthma,beta(2)-agonist,eosinophilic inflammation,inflammatory mediators,inhaled corticosteroids,rhinitis,leukotriene receptor antagonist,systemic inflammation,small airways,shift,paradigm,anti-inflammatory effects},
  language     = {eng},
  number       = {6},
  pages        = {1269--1275},
  publisher    = {Elsevier},
  series       = {Journal of Allergy and Clinical Immunology},
  title        = {Time for a paradigm shift in asthma treatment: From relieving bronchospasm to controlling systemic inflammation},
  url          = {http://dx.doi.org/10.1016/j.jaci.2007.09.017},
  volume       = {120},
  year         = {2007},
}