Airway remodeling in asthma

Ekpruke, Carolyn Damilola; Silveyra, Patricia

doi:10.21037/atm-22-5059

Cited by 1 publication

(2 citation statements)

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“…Current recommendations for the treatment of bronchial asthma (BA) are aimed at controlling symptoms, minimizing the risk of exacerbations and airflow restriction, and inhibiting airway remodeling, but their effectiveness is poor in patients with BA and obesity. Therefore, using remodeling markers as a treatment target is an urgent problem in BA therapy, since there are no specific medications aimed at inhibiting their activity [1,2,3,4].…”

Section: Introduction / вступmentioning

confidence: 99%

“…The lower probability of achieving control and shorter control duration in obese asthma patients compared to patients with healthy weight [5,6] is partially explained by the higher activity of the inflammatory process [7], its neutrophilic type [5,8], as well as higher indicators of remodeling markers [9]. A number of studies have shown that glucocorticoids (GCs) affect both airway inflammation and remodeling processes in BA, although their effect on the extracellular matrix and the content of matrix proteinases (MMPs), tissue inhibitor of matrix metalloproteinases (TIMP)-1 is not very pronounced [10,4]. In light of this and due to the lack of targeted special pharmacotherapy of the BA-obesity phenotype [5,6], as well as the lack of pharmacological methods of inhibiting airway remodeling [3], we consider it reasonable to search for pathogenetically substantiated medications which could complement the limited effect of background therapy on remodeling processes and ensure higher effectiveness of treatment.…”

Section: Introduction / вступmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of Complex Treatment of Patients With Early-Onset and Late-Onset Bronchial Asthma Associated With Obesity

Kachkovska,

Kovchun,

Dudchenko

et al. 2024

EUMJ

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The objective of the study was a comparative assessment of the clinical effectiveness of atorvastatin and vitamin D effect on proteolytic activity in obese patients with BA depending on the age of BA onset. Materials and Methods. We examined 195 patients with BA and obesity and 95 apparently healthy individuals. The patients were divided into 2 groups with regard to the age of BA onset: Group I included 100 patients with early-onset asthma, and Group II included 95 patients with late-onset asthma. Patients with complete BA control at baseline and those having achieved BA control after background therapy adjustment were excluded from further study. Patients of Groups I (n = 65) and II (n = 68) were divided into subgroups A, B, and C: patients of IA (n = 23) and IIA (n = 22) subgroups received background treatment in combination with vitamin D; patients of IB (n = 20) and IIB (n = 25) subgroups – in addition to background treatment received atorvastatin; patients of IC (n = 22) and IIC (n = 21) subgroups received only background treatment. To measure TIMP-1, MMP-1, and MMP-9 levels, IBL International GMBH enzyme-linked immunosorbent assay kits (Hamburg, Germany) were used. Asthma control was assessed using ACQ-5 (Asthma Control Questionnaire-5). The study was approved by the Bioethics Committee of the Academic and Research Medical Institute of Sumy State University. The obtained results were statistically processed using the SPSS–17 program. The results of the study showed that MMP-1, MMP-9, and TIMP-1 levels in obese patients with late-onset BA were significantly higher vs. patients with early-onset BA. Background therapy and its combination with vitamin D or with atorvastatin contributed to a statistically significant decrease in the level of MMP-1, MMP-9, and TIMP-1 in patients of IA, IB, and IC subgroups. MMP-1 level decreased significantly in patients with late-onset BA in all subgroups, but it was significantly lower in patients of IIB subgroup vs. IIA subgroup (p = 0.001) and IIC subgroup (p = 0.001). MMP-9 level decreased significantly in patients of IIA and IIB subgroups, but it was significantly lower in patients of IIB subgroup vs. IIA subgroup (p = 0.001) and IIC subgroup (p = 0.001). This suggested that atorvastatin contributed to a more significant decrease in MMP‑9 level vs. background therapy and background therapy + vitamin D. TIMP-1 level decreased significantly only in patients of IIB subgroup and was lower vs. IIA subgroup (p = 0.001) and IIC subgroup (p = 0.001). We demonstrated higher clinical treatment efficiency in patients of the IA subgroup who received vitamin D in addition to background therapy, which was confirmed by an increase in the level of BA control compared to that in patients of the B (p = 0.01) and C (p = 0.037) subgroups. In patients with late-onset BA (IIB subgroup), atorvastatin contributed to a better BA control compared to patients of IIA and IIC subgroups. The maximum improvement of respiratory function in patients with early-onset BA was achieved with the combination of background therapy + vitamin D, while in patients with late-onset BA – with atorvastatin. Conclusions. The use of atorvastatin has a more significant impact on the level of remodeling markers, BA control, and respiratory function in obese patients with late-onset BA vs. early-onset BA. Better BA control and maximum improvement of respiratory function in obese patients with early-onset BA were achieved with the combination of background therapy + vitamin D.

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Section: Introduction / вступmentioning

confidence: 99%