Asthma: Clinical expression and molecular mechanisms - 11/08/11

Doi : 10.1016/j.jaci.2009.10.047

Robert F. Lemanske, MD ^a,^b,^⁎ , William W. Busse, MD ^a
^a Department of Pediatrics, University of Wisconsin Medical School, Madison, Wis
^b Department of Medicine, University of Wisconsin Medical School, Madison, Wis

Reprint requests: Robert F. Lemanske, Jr, MD, Departments of Pediatrics and Medicine, University of Wisconsin Hospital, 600 Highland Ave K4-916, Madison, WI 53792.

Abstract

Asthma is a complex disorder that displays heterogeneity and variability in its clinical expression both acutely and chronically. This heterogeneity is influenced by multiple factors including age, sex, socioeconomic status, race and/or ethnicity, and gene by environment interactions. Presently, no precise physiologic, immunologic, or histologic characteristics can be used to definitively make a diagnosis of asthma, and therefore the diagnosis is often made on a clinical basis related to symptom patterns (airways obstruction and hyperresponsiveness) and responses to therapy (partial or complete reversibility) over time. Although current treatment modalities are capable of producing control of symptoms and improvements in pulmonary function in the majority of patients, acute and often severe exacerbations still occur and contribute significantly to both the morbidity and mortality of asthma in all age groups. This review will highlight some of the important clinical features of asthma and emphasize recent advances in both pathophysiology and treatment.

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Key words : Asthma, respiratory syncytial virus, rhinovirus, allergen, prevention, exacerbation, inception, treatment

Abbreviations used : API, EBC, EIB, GERD, ICS, LABA, NSAID, RBM, RSV

Plan

Natural history (inception and progression)

Molecular and cellular mechanisms in asthma

Risk factors

Exacerbating factors

Disease progression, prevention, and treatment

Summary

Supported by National Institutes of Health grants 1P01HL70831-01, HL56396, and AI50500.

Disclosure of potential conflict of interest: R. F. Lemanske is a Speaker for Merck, Doembecher Children’s Hospital, Washington University, Medicus Group, Park Nicolet Institute, ACAAI, LA Allergy Society, Michigan Allergy/Asthma Society, Medical College of Wisconsin, Fund for Medical Research and Education (Detroit), Children’s Hospital of Minnesota, Toronto Allergy Society, AAAAI, Beaumont Hospital, University of Illinois, Canadian Society of Allergy and Clinical Immunology, and New York Presbyterian; is a consultant and speaker for AstraZeneca; is a consultant for Map Pharmaceuticals, Gray Consulting, Smith Research, Inc., Merck Childhood Asthma Network, Novartis, Quintiles/Innovax, RC Horowitz & Co, Inc., International Meetings and Science, and Scienomics; is an author for Up-to-Date; and is an Editor for Elsevier, Inc. W. W. Busse is on the Advisory Board for Altair, Amgen, Abbott Laboratories, Asthmatx, Bristol-Meyer Squibb, Centocor, Genentech, GlaxoSmithKline, Merck, Pfizer, Schering-Plough, and Wyeth; is a speaker for Merck, and a consultant for Alexion, AstraZeneca, Boehringer Ingelheim, Dainippon Sumitomo, Funxional Therapeutics Ltd, Novartis, and TEVA; and has received research support from Novartis, Centocor, GlaxoSmithKline, MedImmune, Ception, and the National Institutes of Health–National Institute of Allergy and Infectious Diseases, and the National Heart, Lung, and Blood Institute.