The complex relationship between inflammation and lung function in severe asthma.

Abstract

Asthma is a common respiratory disease affecting approximately 300 million people worldwide. Airway inflammation is thought to contribute to asthma pathogenesis, but the direct relationship between inflammation and airway hyperresponsiveness remains unclear. This study investigates the role of inflammation in a steroid-insensitive, severe allergic airway disease model and in severe asthmatics stratified by inflammatory profile. First, we utilized the TH17 cell adoptive transfer mouse model of asthma to induce pulmonary inflammation, which was lessened by TNFα neutralization or neutrophil depletion. While decreased airspace inflammation following TNFα neutralization and neutrophil depletion rescued lung compliance, neither intervention improved airway hyperresponsiveness to methacholine, and tissue inflammation remained elevated when compared to control. Further, sputum samples were collected and analyzed from 41 severe asthmatics. In severe asthmatics with elevated levels of sputum neutrophils, but low levels of eosinophils, increased inflammatory markers did not correlate with worsened lung function. This subset of asthmatics also had significantly higher levels of TH17-related cytokines in their sputum compared to other severe asthmatics with other inflammatory phenotypes. Overall, this work suggests that lung compliance may be linked with cellular inflammation in the airspace, while T cell-driven airway hyperresponsiveness may be associated with tissue inflammation and other pulmonary factors.