Targeted anti-inflammatory therapeutics in asthma and chronic obstructive lung disease.
Asthma and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases of the airway, although the drivers and site of the inflammation differ between diseases. Asthmatics with a neutrophilic airway inflammation are associated with a poor response to corticosteroids, whereas asthmatics with eosinophilic inflammation respond better to corticosteroids. Biologicals targeting the Th2-eosinophil nexus such as anti-interleukin (IL)-4, anti-IL-5, and anti-IL-13 are ineffective in asthma as a whole but are more effective if patients are selected using cellular (eg, eosinophils) or molecular (eg, periostin) biomarkers. This highlights the key role of individual inflammatory mediators in driving the inflammatory response and for accurate disease phenotyping to allow greater understanding of disease and development of patient-oriented antiasthma therapies. In contrast to asthmatic patients, corticosteroids are relatively ineffective in COPD patients. Despite stratification of COPD patients, the results of targeted therapy have proved disappointing with the exception of recent studies using CXC chemokine receptor (CXCR)2 antagonists. Currently, several other novel mediator-targeted drugs are undergoing clinical trials. As with asthma specifically targeted treatments may be of most benefit in specific COPD patient endotypes. The use of novel inflammatory mediator-targeted therapeutic agents in selected patients with asthma or COPD and the detection of markers of responsiveness or nonresponsiveness will allow a link between clinical phenotypes and pathophysiological mechanisms to be delineated reaching the goal of endotyping patients.
Airway Diseases Section, National Heart and Lung Institute, Imperial College London, London, UK; Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK. Electronic address: a.durham@imperial.ac.uk.
Andrew L
AL
Durham
Section of Respiratory Diseases, Centro per lo Studio delle Malattie Infiammatorie Croniche delle Vie Aeree e Patologie Fumo Correlate dell'Apparato Respiratorio (CEMICEF; ex Centro di Ricerca su Asma e BPCO), Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Ferrara, Italy.
Gaetano
G
Caramori
Airway Diseases Section, National Heart and Lung Institute, Imperial College London, London, UK; Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.
Kian F
KF
Chung
Airway Diseases Section, National Heart and Lung Institute, Imperial College London, London, UK; Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK.
Ian M
IM
Adcock
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents