The Pathology of Asthma: What Is Obstructing Our View?

Despite the advent of sophisticated and efficient new biologics to treat inflammation in asthma, the disease persists. Even following treatment, many patients still experience the well-known symptoms of wheezing, shortness of breath, and coughing. What are we missing? Here we examine the evidence th...

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Bibliographic Details
Published in:Annual review of pathology 2023-01, Vol.18 (1), p.387-409
Main Authors: Aegerter, Helena, Lambrecht, Bart N
Format: Article
Language:English
Subjects:
airway obstruction
asthma
Asthma - pathology
galectin-10
Humans
Inflammation
Mucus
neutrophils
Sputum
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Summary:Despite the advent of sophisticated and efficient new biologics to treat inflammation in asthma, the disease persists. Even following treatment, many patients still experience the well-known symptoms of wheezing, shortness of breath, and coughing. What are we missing? Here we examine the evidence that mucus plugs contribute to a substantial portion of disease, not only by physically obstructing the airways but also by perpetuating inflammation. In this way, mucus plugs may act as an immunogenic stimulus even in the absence of allergen or with the use of current therapeutics. The alterations of several parameters of mucus biology, driven by type 2 inflammation, result in sticky and tenacious sputum, which represents a potent threat, first due to the difficulties in expectoration and second by acting as a platform for viral, bacterial, or fungal colonization that allows exacerbations. Therefore, in this way, mucus plugs are an overlooked but critical feature of asthmatic airway disease.
ISSN:1553-4006
1553-4014
DOI:10.1146/annurev-pathol-042220-015902