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Lung cells in asthma - protectors or drivers of disease.

This review is a thorough, if not disturbing, examination of the sentinel role of the airway epithelium in asthma. It also questions the current, generalized classification and treatment of chronic and severe asthma.
Armed with new research findings on innate immune reactions to environmental 'insults' it is clear from this review that clinical diagnosis and treatments of asthma have not kept pace with research or messaging from opinion leaders in the disease. To classify and treat chronic asthma as allergic or non-allergic, or symptoms that are mild, moderate or severe, is too crude a tool. The author suggests new therapies to improve airway resistance to environmental insults rather than suppressing the cause of inflammation. This, as the author states, may raise the stakes of treating asthma to one of curing this disease'.

This review is a 'must read' for health care workers in asthma management. Below are some of the subject matters raised.

  • The mechanical working of a healthy airway epithelium.
  • Structural changes in the epithelium before inflammation and the diagnosis of asthma.
  • Proteins that form the epithelium tight junctions and environmental products that can disrupt the barrier.
  • Absence of lung dendritic cells at birth.
  • How asthma affects different areas of the lung, initially affecting the conducting airways but can also spread to the trachea, larynx, small airways, and alveoli.
  • The formation and function of the airway epithelium in persistent asthma.
  • Chronic remodelling of the airways and the fact that this may possibly happen independently of outside stimuli.
  • A Th2 response without increasing IgE markers in non-atopic asthma.
  • Localised IgE in non-atopic asthma.
  • Airway viral infections can be persistent or severe in asthma and non-responsive to the common practice of doubling steroid treatment.

These are examples of the subject matter discussed in this excellent review.


'The sentinel role of the airways epithelium in asthma pathogenesis, Stephen T Holgate, 'Immunological Reviews', 2011, Vol. 242; 205-219