Measuring Airway Inflammation

Airways diseases form the bulk of the respiratory illnesses seen by Pulmonologists and in particular, asthma and chronic obstructive pulmonary disease. The pathogenesis common to both these illness is inflammation. Although it was initially thought that asthma was a disease of the larger airways a significant body of research has refuted this long held belief. We have now begun to understand that both chronic obstructive pulmonary disease and asthma are inflammatory airways diseases that predominantly affect the small airways and to a lesser extent the larger airways. Hence, all the new drug development has been aimed at either better drug delivery to the smaller airways or suppression of inflammation in the airways. The fallacy in our current assessment of patients with asthma has been the assumption that by titrating therapeutic interventions to normalize symptom control and improve airflow dynamics we will have suppressed the inflammation present in the airways. This is not true as airway inflammation persists despite normalization of spirometric parameters and control of asthmatic symptoms. Unfortunately, there are several studies demonstrating persistent airway inflammation despite appropriate aggressive therapy and control of patient symptoms. Assessment of inflammation—“Inflammometry”—is now being increasingly used to titrate our therapeutic interventions to achieve better asthma control.