Serine Protease Imbalance in the Small Airways and Development of Centrilobular Emphysema in Chronic Obstructive Pulmonary Disease

2020 ◽  
Vol 63 (1) ◽  
pp. 67-78 ◽  
Author(s):  
Kiyoshi Uemasu ◽  
Naoya Tanabe ◽  
Kazuya Tanimura ◽  
Koichi Hasegawa ◽  
Tatsushi Mizutani ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Serine Protease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Small Airways ◽  
Obstructive Pulmonary Disease

scholarly journals Small airways disease in mild and moderate chronic obstructive pulmonary disease: a cross-sectional study

2018 ◽  
Vol 6 (8) ◽  
pp. 591-602 ◽  
Author(s):  
Hyun-Kyoung Koo ◽  
Dragoş M Vasilescu ◽  
Steven Booth ◽  
Aileen Hsieh ◽  
Orestis L Katsamenis ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Small Airways ◽  
Sectional Study ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease

scholarly journals The role of airway remodeling in the pathogenesis and treatment of chronic obstructive pulmonary disease

2021 ◽  
Vol 8 (3) ◽  
pp. 96-102
Author(s):  
Nightingale Syabbalo
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Epithelial Cells ◽  
Pulmonary Disease ◽  
Airway Remodeling ◽  
Inflammatory Cells ◽  
Lymphoid Cells ◽  
Standards Of Care ◽  
Chronic Obstructive ◽  
Small Airways ◽  
Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is currently considered the third leading cause of death in the world. COPD represents an important public health challenge and a socio-economical problem that is preventable and treatable. The main cause of COPD is chronic inhalation of cigarette smoke, and other harmful constituents of air pollution, which cause epithelial injury, chronic inflammation and airway remodeling. Airway remodeling is most prominent in small airways. It is due to infiltration of the airways by inflammatory cells, such as neutrophils, eosinophils, macrophages, and immune cells, including CD8+ T-cells, Th1, Th17 lymphocytes, and innate lymphoid cells group 3. Fibroblasts, myofibroblasts, and airway smooth muscle (ASM) cells also contribute to airway remodeling by depositing extracellular matrix (ECM) proteins, which increase the thickness of the airway wall. Activated inflammatory cells, and structural cells secrete cytokines, chemokines, growth factors, and enzymes which propagate airway remodeling. Airway remodeling is an active process which leads to thickness of the reticular basement membrane, subepithelial fibrosis, peribronchiolar fibrosis, and ASM cells hyperplasia and hypertrophy. It is also accompanied by submucosal glands and goblet cells hypertrophy and mucus hypersecretion, and angiogenesis. Epithelial mesenchymal transmission (EMT) plays a key role in airway remodeling. In patients with COPD and smokers, cellular reprograming in epithelial cells leads to EMT, whereby epithelial cells assume a mesencymal phenotype. Additionally, COPD is associated with increased parasympathetic cholinergic activity, which leads to ASM cells hypercontractility, increased mucus secretion, and vasodilatation. Treatment of COPD is intricate because of the heterogeneous nature of the disease, which requires specific treatment of the pathophysiological pathways, such as airway inflammation, ASM cell hypercontractility, and parasympathetic cholinergic hyperreactivity. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 strategy report recommends personalized approach for the treatment of COPD. However, some patients with COPD are unresponsive to the standards of care. They may require a triple combination of LABA/LAMA/ICS. Single-inhaler triple therapy (SITT), such as fluticasone fuorate/vilanterol/umeclidinium has been shown to significantly improve symptoms and asthma control, reduce moderate and severe exacerbations, and to improve lung function.

scholarly journals Issues of triple therapy of chronic obstructive pulmonary disease. Comments to the algorithm. A resolution of expert panel, June 13, 2018, Vladivostok

2019 ◽  
Vol 29 (3) ◽  
pp. 365-374
Author(s):  
S. N. Avdeev ◽  
V. A. Nevzorova ◽  
L. M. Kudelya ◽  
N. M. Kondrashova ◽  
G. I. Sukhanova ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Patient Adherence ◽  
Chronic Obstructive ◽  
Primary Concern ◽  
Small Airways ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Increased Risk

Minimizing the risk of exacerbations of chronic obstructive pulmonary disease (COPD) along with symptoms control are the most important therapeutic tasks in COPD. The effective solution of this problem is still being discussed. The prevention of COPD exacerbations is of social and economic importance and should be the primary concern in the treatment of this disease. Unresolved problems in the treatment of COPD are low patient compliance to therapy and side effects of medication. According to recent guidelines, in case of persistent COPD exacerbations with patients receiving long-acting bronchodilators (LABA), the use of inhaled corticosteroids (ICS) must be considered; this reduces the incidence of moderate and severe COPD exacerbations, especially if a patient has a history of bronchial asthma or blood and/or sputum eosinophilia. Availability of LABA/LAMA and ICS/LABA fixed combinations in Russia provides two possible options to administer a free triple combination consisting of a single LAMA plus ICS/LABA or ICS plus LAMA/LAMA. According to multiple trials, the use of fixed combinations could provide twice improvement in the patient adherence to the therapy, which therefore leads to higher efficiency. The main complaint about ICS with COPD patients is an increased risk of pneumonia as well as the development of systemic adverse reactions typical for corticosteroids. However, the use of extra-fine ICS could significantly reduce the risk of pneumonia compared with fine-particle inhalators and also increases the effectiveness of therapy as the pathological process in COPD mainly involves the small airways.

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