Clinical Usefulness of Inflammatory Markers in Asthma
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Am J Respir Med 2003; 2 (1): 11-19 1175-6365/03/0001-0011/$30.00/0 © Adis International Limited. All rights reserved.
Clinical Usefulness of Inflammatory Markers in Asthma Peter A.B. Wark1 and Peter G. Gibson2 1 Research Division, Respiratory Cell and Molecular Biology, Southampton General Hospital, Southampton, UK 2 Department of Respiratory and Sleep Medicine, John Hunter Hospital, The University of Newcastle, and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
Abstract
Asthma is a significant and increasing health problem. Airway inflammation and hyperresponsiveness are key pathophysiological mechanisms underlying asthma. Currently, effective treatments target these two processes and can lead to clinically important improvements in disease control. At present, decisions to initiate or modify therapy are based on symptoms and measures of airway caliber, with no direct assessment of airway inflammation or hyperresponsiveness. It is now possible to measure airway inflammation using noninvasive markers such as exhaled gases, induced sputum and serum measurements. Exhaled nitric oxide (eNO) and induced sputum eosinophils show the greatest promise as clinically useful markers of airway inflammation in asthma. Induced sputum can now be applied to the diagnosis of airway diseases, based on its ability to detect eosinophilic bronchitis in cough, and to differentiate between eosinophilic and non-eosinophilic asthma. The place of induced sputum and eNO in the ongoing monitoring of patients with asthma are now being investigated in controlled trials.
Asthma has been defined as a chronic inflammatory disease of the airways characterized by variable airflow obstruction and bronchial hyperresponsiveness. Airway inflammation is recognized as central to the development and progression of asthma, and a considerable amount of research has defined the mechanisms associated with inflammation in asthma.[1] Anti-inflammatory treatments, particularly inhaled corticosteroids, have targeted airway inflammation resulting in substantial improvements in asthma control.[2] Despite this, the direct measurement of inflammatory markers is not part of the routine clinical assessment in the management of asthma. If measures of airway inflammation are to become widely adopted for use in clinical practice, a number of requirements need to be fulfilled. The investigation needs to be clinically beneficial either in the diagnosis or management of asthma; it needs to be validated and reproducible other than in centers with a particular research interest and finally, it needs to be acceptable in terms of cost and safety. This article explores the techniques of sputum induction, exhaled gas measures and blood or serum measures of eosinophilic inflammation as noninvasive measures of airway inflammation in terms of their potential clinical usefulness in asthma.
1. Induced Sputum Sputum induction aims to directly sample inflammatory cells from the lower respiratory tract using an inhalation of hypertonic saline. In asthma, hype
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