Regulation of macrophage polarization in chronic airway inflammatory diseases: immune interactions, metabolic reprogramming, and beyond

Chronic upper and lower airway inflammatory diseases (such as allergic rhinitis, chronic rhinosinusitis, and bronchial asthma) are a group of highly heterogeneous disorders primarily characterized by immune imbalance and persistent inflammation as their core features, which seriously affect patients' quality of life. As an important component of the immune system, macrophages can undergo functional polarization in response to distinct inflammatory microenvironments, exerting divergent pro-inflammatory or anti-inflammatory effects. They also form intricate interaction networks with other immune cells to jointly regulate the progression of chronic airway inflammation. Although the regulation of macrophage plasticity is regulated by multiple aspects, metabolic reprogramming has emerged as a pivotal mechanism modulating macrophage polarization and function. This review systematically summarizes the interplay between macrophage polarization and other immune cells, focusing on the impact of distinct phenotypes and their regulatory pathways on chronic airway inflammatory diseases. Furthermore, we discuss the therapeutic potential of targeting metabolic reprogramming, providing new insights for the precise treatment of chronic upper and lower airway inflammatory diseases.