Invited Review Series: Respiratory Disease: Using Lung Function Measurements to Greater Advantage
You have free access to this content
Article first published online: 24 JUL 2014
DOI: 10.1111/resp.12355
© 2014 Asian Pacific Society of Respirology
Additional Information(Show All)
- The Authors: Giuseppe Francesco Sferrazza Papa, MD, is a Fellow in Respiratory Medicine with interest in chronic obstructive pulmonary diseases, lung function and imaging techniques. Giulia Michela Pellegrino, MD, is a Fellow in Respiratory Medicine with interest in chronic obstructive pulmonary diseases, lung function and clinical research. Riccardo Pellegrino, MD, is Chief of the Department of Allergology and Respiratory Pathophysiology with interest in chronic obstructive pulmonary diseases, lung and airway mechanics, airway hyperresponsiveness and exercise physiology.
- Series Editors: Graham L. Hall and Charles G. Irvin
Abstract
Bronchial asthma is a chronic disease characterized by airway hyperresponsiveness, airway inflammation and remodelling. The hypothesis that the illness is inflammatory in nature has recently been challenged by studies showing that airway smooth muscle (ASM) plays a more important role than previously thought. For example, it is now known that in asthma patients, ASM proliferates more and faster than in healthy subjects, carries intrinsic defects and exhibits impaired relaxation, increased velocity of shortening, plastic adaptation to short length and perturbed equilibrium of actin-to-myosin during cycling. Similar conclusions can be drawn from studies on airway mechanics. For instance, in asthma, abnormal ASM contributes to limiting the response to deep lung stretching and accelerates the return of bronchial tone to baseline conditions, and contributes to increased airway stiffness. Upon stimulation, ASM causes airway narrowing that is heterogeneous across the lung and variable over time. This heterogeneity leads to patchy ventilation. Experimental studies have shown that patchy ventilation may precipitate an asthma attack, and inability to maintain bronchial tone control over time can predict the occurrence of bronchospastic attacks over a matter of a few days. To improve our knowledge on the pathogenesis of asthma, we believe that it is necessary to explore the disease within the framework of the topographical, volume and time domains of the lung that play an important role in setting the severity and progression of the disease. Application of the forced oscillation technique and multiple breath nitrogen washout may, alone or in combination, help address questions unsolvable until now.
No comments:
Post a Comment