Real-world evaluation studies have shown that many patients with asthma remain symptomatic despite treatment with inhaled corticosteroids (ICSs). As conventional ICSs have poor access to the peripheral airways, the aim of the present paper was to study the relationship between peripheral airway inflammation and clinical control in allergic asthma. Consequently, bronchial and transbronchial biopsies were obtained from patients with poorly controlled asthma [n=12, asthma control test (ACT) score < 20], patients with well-controlled asthma (n=12, ACT score ≥ 20) and healthy controls (n=8). Tissue sections were immunostained to assess multiple leucocyte populations. To determine the degree of T-helper type-2 (Th2) immunity, the logarithmic value of the ratio between Th2 cells/mm2 and Th1 cells/mm2 was used as a surrogate score for Th2-skewed immunity. In the bronchi, the leucocyte infiltration pattern and the Th2-score were similar between patients with well-controlled asthma and those with poorly controlled asthma. In contrast, in the alveolar parenchyma, the expression of T-helper cells was significantly higher in patients with poorly controlled asthma than in patients with well-controlled asthma (P<0.01). Furthermore, the alveolar Th2-score was significantly higher in patients with poorly controlled asthma (median 0.4) than in the controlled patients (median −0.10, P<0.05). In addition, in contrast with bronchial Th2-score, the alveolar Th2-score correlated significantly with ACT score (rs=−0.62, P<0.01) in the pooled asthma group. Collectively, our data reveal an alveolar Th2-skewed inflammation, specifically in asthmatic patients who are poorly controlled with ICSs, and suggest that pharmacological targeting of the peripheral airways may be beneficial in this large patient category.
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Research Article|
August 29 2014
Alveolar T-helper type-2 immunity in atopic asthma is associated with poor clinical control
Anders Bergqvist;
Anders Bergqvist
*Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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Cecilia K. Andersson;
Cecilia K. Andersson
*Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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Michiko Mori;
Michiko Mori
†Department of Experimental Medical Sciences, Lund University, Lund, Sweden
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Andrew F. Walls;
Andrew F. Walls
‡Clinical and Experimental Sciences, University of Southampton, Southampton General Hospital, Southampton, U.K.
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Leif Bjermer;
Leif Bjermer
*Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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Jonas S. Erjefält
*Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
†Department of Experimental Medical Sciences, Lund University, Lund, Sweden
Correspondence: Professor Jonas S. Erjefält (email Jonas.erjefalt@med.lu.se).
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Publisher: Portland Press Ltd
Received:
May 15 2014
Revision Received:
July 21 2014
Accepted:
July 25 2014
Accepted Manuscript online:
July 25 2014
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2015 Biochemical Society
2015
Clin Sci (Lond) (2015) 128 (1): 47–56.
Article history
Received:
May 15 2014
Revision Received:
July 21 2014
Accepted:
July 25 2014
Accepted Manuscript online:
July 25 2014
Citation
Anders Bergqvist, Cecilia K. Andersson, Michiko Mori, Andrew F. Walls, Leif Bjermer, Jonas S. Erjefält; Alveolar T-helper type-2 immunity in atopic asthma is associated with poor clinical control. Clin Sci (Lond) 1 January 2015; 128 (1): 47–56. doi: https://doi.org/10.1042/CS20140309
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