Fixed Airflow Obstruction in Asthma: A Problem of the Whole Lung Not of Just the Airways

Frontiers in Physiology

Troy J. Cross²  Cindy Thamrin²  Gregory G. King²  Katrina O. Tonga³  Sandra Rutting⁴ 

[1] Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia;Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia;St Vincent’s Healthcare Clinical Campus, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia;The Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia;The Department of Thoracic and Transplant Medicine, St Vincent’s Hospital, Sydney, NSW, Australia;

关键词: asthma;    fixed airflow obstruction;    airway remodeling;    parenchymal remodeling;    lung elastic recoil;   

DOI  :  10.3389/fphys.2022.898208

来源: DOAJ

【 摘 要 】

Abstract Asthma with irreversible or fixed airflow obstruction (FAO) is a severe clinical phenotype that is difficult to treat and is associated with an accelerated decline in lung function and excess morbidity. There are no current treatments to reverse or prevent this excessive decline in lung function in these patients, due to a lack of understanding of the underlying pathophysiology. The current paradigm is that FAO in asthma is due to airway remodeling driven by chronic inflammation. However, emerging evidence indicates significant and critical structural and functional changes to the lung parenchyma and its lung elastic properties in asthma with FAO, suggesting that FAO is a ‘whole lung’ problem and not just of the airways. In this Perspective we draw upon what is known thus far on the pathophysiological mechanisms contributing to FAO in asthma, and focus on recent advances and future directions. We propose the view that structural and functional changes in parenchymal tissue, are just as (if not more) important than airway remodeling in causing persistent lung function decline in asthma. We believe this paradigm of FAO should be considered when developing novel treatments.

【 授权许可】

Unknown