Immunopathological and Structural Alterations in Difficult to Control Asthma
type: CreativeWork
description: Asthma is a chronic respiratory disorder affecting an estimated 300 million people worldwide. Most patients with asthma can be controlled with bronchodilators and low to moderate dose inhaled corticosteroids. However, an estimated 5-10% of the population presents a more troublesome disease, often referred to as severe asthma. The aim of present thesis was to study the relationship between histopathological alterations and clinical control in patients with different severities of asthma. To study this, a detailed immunohistochemical analysis was performed on lung biopsies obtained from moderate asthmatics (n = 24 in Paper I), severe asthmatics (n = 25 in Paper II), and uncontrolled severe asthmatics undergoing bronchial thermoplasty treatment (n = 15 and n = 20 in Paper III and IV, respectively). In Paper I, we show that allergic airway inflammation extends to the peripheral airways specifically in patients that are poorly controlled. This suggests that targeting peripheral airway inflammation, for example with extrafine-particle formulations of inhaled corticosteroids, may benefit patients that remain symptomatic despite standard inhaled corticosteroid treatment. In Paper II, we found that symptomatic severe asthma is associated with lower number of eosinophils and no apparent signs of chronic inflammation as compared with stable severe asthma. However, we detected stretches of bronchoepithelial metaplasia in the former patient category suggesting that external assaults, possible episodic pathogen infections, may play an important role in this form of asthma. In Paper III, we show that bronchial thermoplasty markedly improves several elements of clinical control in patients with uncontrolled severe asthma. The clinical improvements were associated with a down-regulation of structures involved in airway narrowing and hyperreactivity, including airway smooth muscle, neuroendocrine epithelial cells, and nerve fibres. In Paper IV, we show that bronchial thermoplasty tre…
abstract: Asthma is a chronic respiratory disorder affecting an estimated 300 million people worldwide. Most patients with asthma can be controlled with bronchodilators and low to moderate dose inhaled corticosteroids. However, an estimated 5-10% of the population presents a more troublesome disease, often referred to as severe asthma. The aim of present thesis was to study the relationship between histopathological alterations and clinical control in patients with different severities of asthma. To study this, a detailed immunohistochemical analysis was performed on lung biopsies obtained from moderate asthmatics (n = 24 in Paper I), severe asthmatics (n = 25 in Paper II), and uncontrolled severe asthmatics undergoing bronchial thermoplasty treatment (n = 15 and n = 20 in Paper III and IV, respectively). In Paper I, we show that allergic airway inflammation extends to the peripheral airways specifically in patients that are poorly controlled. This suggests that targeting peripheral airway inflammation, for example with extrafine-particle formulations of inhaled corticosteroids, may benefit patients that remain symptomatic despite standard inhaled corticosteroid treatment. In Paper II, we found that symptomatic severe asthma is associated with lower number of eosinophils and no apparent signs of chronic inflammation as compared with stable severe asthma. However, we detected stretches of bronchoepithelial metaplasia in the former patient category suggesting that external assaults, possible episodic pathogen infections, may play an important role in this form of asthma. In Paper III, we show that bronchial thermoplasty markedly improves several elements of clinical control in patients with uncontrolled severe asthma. The clinical improvements were associated with a down-regulation of structures involved in airway narrowing and hyperreactivity, including airway smooth muscle, neuroendocrine epithelial cells, and nerve fibres. In Paper IV, we show that bronchial thermoplasty tre…
author: Bergqvist, Anders
language: eng
keywords: Respiratory Medicine and Allergy, Severe asthma, bronchial thermoplasty, airway smooth muscle, neuroendocrine cells, inflammation, immune cells, remodelling
date published: 2015
date modified: 2026-07-24T02:59:36Z
provider: University of Lund
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Department of Respiratory Medicine and Allergology, Lund University