Clinical update on the use of biomarkers of airway inflammation in the management of asthma

Abstract

Biological markers are already used in the diagnosis and treatment of cardiovascular disease and cancer. Biomarkers have great potential use in the clinic as a noninvasive means to make more accurate diagnoses, monitor disease progression, and create personalized treatment regimes. Asthma is a heterogeneous disease with several different phenotypes, generally triggered by multiple gene-environment interactions. Pulmonary function tests are most often used objectively to confirm the diagnosis. However, airflow obstruction can be variable and thus missed using spirometry. Furthermore, lung function measurements may not reflect the precise underlying pathological processes responsible for different phenotypes. Inhaled corticosteroids and β2-agonists have been the mainstay of asthma therapy for over 30 years, but the heterogeneity of the disease means not all asthmatics respond to the same treatment. High costs and undesired side effects of drugs also drive the need for better targeted treatment of asthma. Biomarkers have the potential to indicate an individual’s disease phenotype and thereby guide clinicians in their decisions regarding treatment. This review focuses on biomarkers of airway inflammation which may help us to identify, monitor, and guide treatment of asthmatics. We discuss biomarkers obtained from multiple physiological sources, including sputum, exhaled gases, exhaled breath condensate, serum, and urine. We discuss the inherent limitations and benefits of using biomarkers in a heterogeneous disease such as asthma. We also discuss how we may modify our study designs to improve the identification and potential use of potential biomarkers in asthma.

Serum Periostin Level in Children with Bronchial Asthma: A Comparative Study

“…Our study gets its strength from the significant correlation between elevated serum periostien level and impaired pulmonary function. The standard assessment of remodeling is obtained by tissue biopsy through bronchoscopy which is costly and sophisticated invasive procedure that needs experts especially for evaluation of distal air way 20 . Instead air way remodeling was assessed by measuring serum level of periostien which can assess both airway inflammation and remodeling which was correlated with air way obstruction as determined by impaired FEV1.…”

Usefulness of Noninvasive Methods for the Study of Bronchial Inflammation in the Control of Patients with Asthma

“…To separate cells from the sputum fluid phase, the sample must be centrifuged and the cell concentration adjusted to 1.0 × 10 6 cells/ml, in order to perform a cytospin preparation for cytocentrifugation. After cytospin staining, the differential cellular count is determined by counting a minimum of 400 nonsquamous cells, and is reported as relative numbers of eosinophils, neutrophils, lymphocytes, macrophages and epithelial cells [26] (fig. 1).…”

Increased circulating IL-9-producing CD8+ T cells are associated with eosinophilia and high FeNO in allergic asthmatics

“…FeNO is an indirect biomarker of airway inflammation in asthmatic patients (28). FeNO is often increased in steroid-sensitive asthmatics, and is correlated with eosinophilia (29,30).…”