Abstract
It is increasingly recognized that asthma represents a syndrome, and there is clinical and pathobiological heterogeneity. Many genes are reported to be associated with asthma, and may be involved in the disease heterogeneity. Diverse cells, such as T helper 1 (Th1)-cells, Th2-cells, Th17-cells, airway epithelial cells, and innate and adaptive immunity associated cells, contribute to the pathobiology of asthma independently of each other or they can also coexist and interact. Although, generally, Th2 immunity is important in most asthma endotypes, non- Th2-driven inflammation tends to be difficult to manage. Recently, increased attention has been focused on severe asthma and glucocorticoid (GC)-resistant (GC-R) asthma, in which diverse inflammatory processes may be involved. Treatment approaches should take into account pathological differences.
Highlights
Asthma is a chronic inflammatory disease characterized by episodic and reversible airway obstruction and bronchial hyper-responsiveness
The adoptive transfer of antigen-specific T helper 1 (Th1) cells into ovalbumin-challenged mice led to the development of airway hyper-responsiveness and airway inflammation that was independent of IL-13 and IL-4 [8]
High mobility group box 1 (HMGB-1), a ligand of the receptor for advanced glycation end products (RAGE), is a mediator of neutrophilic airway inflammation in asthma, and imbalance between HMGB-1 and esRAGE is related to the severity of asthma [27]
Summary
Asthma is a chronic inflammatory disease characterized by episodic and reversible airway obstruction and bronchial hyper-responsiveness. Age at onset, exacerbating factors, and response to treatment differ in each individual. In common with other complex diseases, asthma is a heterogeneous and genetically complex disease, and in some patients factors can coexist [1,2,3]. Despite conventional therapy, including bronchodilators, leukotriene modifiers, and GCs, some patients do not respond satisfactorily to therapy, and attention is focused on severe and GC-R asthma. Accurate definition of asthmatic phenotypes may facilitate clinical investigation of the pathogenesis and be useful for treatment of asthma. This review summarizes the clinical and pathobiological phenotypes of asthma, and discusses the mechanisms of GC resistance
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