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Wechsler ME, Wells JM. What every clinician should know about inflammation in COPD. ERJ Open Res 2024; 10:00177-2024. [PMID: 39319045 PMCID: PMC11417604 DOI: 10.1183/23120541.00177-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/22/2024] [Indexed: 09/26/2024] Open
Abstract
Inflammation drives COPD pathogenesis and exacerbations. Although the conceptual framework and major players in the inflammatory milieu of COPD have been long established, the nuances of cellular interactions and the etiological differences that create heterogeneity in inflammatory profiles and treatment response continue to be revealed. This wealth of data and understanding is not only a boon to the researcher but also provides guidance to the clinician, moving the field closer to precision medicine. It is through this lens that this review seeks to describe the inflammatory processes at play in COPD, relating inflammation to pathological and functional changes, identifying patient-specific and disease-related factors that may influence clinical observations, and providing current insights on existing and emerging anti-inflammatory treatments and treatment targets, including biological therapies and phosphodiesterase (PDE) inhibitors.
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Affiliation(s)
- Michael E. Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - J. Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Ambrosino P, Marcuccio G, Raffio G, Formisano R, Candia C, Manzo F, Guerra G, Lubrano E, Mancusi C, Maniscalco M. Endotyping Chronic Respiratory Diseases: T2 Inflammation in the United Airways Model. Life (Basel) 2024; 14:899. [PMID: 39063652 PMCID: PMC11278432 DOI: 10.3390/life14070899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Over the past 15 years, the paradigm of viewing the upper and lower airways as a unified system has progressively shifted the approach to chronic respiratory diseases (CRDs). As the global prevalence of CRDs continues to increase, it becomes evident that acknowledging the presence of airway pathology as an integrated entity could profoundly impact healthcare resource allocation and guide the implementation of pharmacological and rehabilitation strategies. In the era of precision medicine, endotyping has emerged as another novel approach to CRDs, whereby pathologies are categorized into distinct subtypes based on specific molecular mechanisms. This has contributed to the growing acknowledgment of a group of conditions that, in both the upper and lower airways, share a common type 2 (T2) inflammatory signature. These diverse pathologies, ranging from allergic rhinitis to severe asthma, frequently coexist and share diagnostic and prognostic biomarkers, as well as therapeutic strategies targeting common molecular pathways. Thus, T2 inflammation may serve as a unifying endotypic trait for the upper and lower airways, reinforcing the practical significance of the united airways model. This review aims to summarize the literature on the role of T2 inflammation in major CRDs, emphasizing the value of common biomarkers and integrated treatment strategies targeting shared molecular mechanisms.
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Giuseppina Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (G.R.)
| | - Giuseppina Raffio
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (G.R.)
| | - Roberto Formisano
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (E.L.)
| | - Claudio Candia
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| | - Fabio Manzo
- Fleming Clinical Laboratory, 81020 Casapulla, Italy;
| | - Germano Guerra
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Ennio Lubrano
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (E.L.)
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II University, 80131 Naples, Italy;
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (G.R.)
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
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Zhou Z, Shen C, Long W, Chen J, Lu J, Gao L, Hu Y, Yu M, Wu X, Shao J. Simultaneous real-time detection of fractional exhaled nitric oxide and end-tidal carbon dioxide by quantum cascade laser absorption spectroscopy. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 308:123750. [PMID: 38113557 DOI: 10.1016/j.saa.2023.123750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
The simultaneous detection of fractional exhaled nitric oxide (FeNO) and end-tidal carbon dioxide (ETCO2) is of great importance for the distinguishing and diagnosis of asthma and chronic obstructive pulmonary disease (COPD), providing more comprehensive information on respiratory disorders. This work demonstrates a simultaneous ETCO2 and FeNO detection system based on quantum cascade laser absorption spectroscopy (QCLAS) technology was presented. The system employs wavelength modulation spectroscopy (WMS) technology and the Herriott multi-pass cell, achieving a detection limit of 2.82 ppb for nitric oxide (NO) and 0.05 % for carbon dioxide (CO2). Real-time exhalation measurements were performed on volunteers with varying ETCO2 and FeNO levels, and the results of the test can accurately distinguish whether the corresponding volunteer was healthy, had asthma or COPD. The effect of exhalation flow rate on the concentration of the two gases was explored. A range of expiratory flow rates were tested in the flow rate interval from 1 to 4 L/min, and there was always an inverse relationship between expiratory flow rate and FeNO concentration, but flow rate changes did not affect ETCO2 concentration. The results indicate that this detection system can simultaneously and effectively measure ETCO2 and FeNO concentrations in real-time.
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Affiliation(s)
- Zhiming Zhou
- Key Laboratory of Optical Information Detection and Display Technology of Zhejiang, Zhejiang Normal University, Jinhua 321004, China
| | - Chenying Shen
- Key Laboratory of Optical Information Detection and Display Technology of Zhejiang, Zhejiang Normal University, Jinhua 321004, China
| | - Wei Long
- Key Laboratory of Optical Information Detection and Display Technology of Zhejiang, Zhejiang Normal University, Jinhua 321004, China
| | - Jinling Chen
- Key Laboratory of Optical Information Detection and Display Technology of Zhejiang, Zhejiang Normal University, Jinhua 321004, China
| | - Juncheng Lu
- Key Laboratory of Optical Information Detection and Display Technology of Zhejiang, Zhejiang Normal University, Jinhua 321004, China
| | - Lu Gao
- Key Laboratory of Optical Information Detection and Display Technology of Zhejiang, Zhejiang Normal University, Jinhua 321004, China
| | - Yanyan Hu
- Jinhua Guangfu Cancer Hospital, Jinhua 321099, China
| | - Meifang Yu
- Jinhua Guangfu Cancer Hospital, Jinhua 321099, China
| | - Xiaoyu Wu
- Jinhua Guangfu Cancer Hospital, Jinhua 321099, China.
| | - Jie Shao
- Key Laboratory of Optical Information Detection and Display Technology of Zhejiang, Zhejiang Normal University, Jinhua 321004, China.
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