|Andrzej M. Fal, Robert Pawłowicz |
Bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD)
are recognized as a group of obstructive diseases where obstruction to
the air flow in the lower airways is the leading pathophysiological feature.
In BA bronchoconstriction is accompanied by a chronic inflammatory
reaction where eosinophils together with Th2 lymphocytes play the main
role. Chronic inflammation leads to airway remodeling, a process that is
in part genetically predetermined. Major effects of airways remodeling
in BA are basal membrane thickening (in fact an optical effect resulting
from a massive protein deposition) and smooth muscle area enlargement
due to hypertrophy and hyperplasia. In COPD the chronic inflammation
involves mainly neutrophils and macrophages and is Th1 driven. Airway
remodeling involves both bronchial wall and lung parenchyma. Destruction
of the alveolar walls leads to emphysema. The decline in the number
of alveolar attachments to distal bronchi results in their lumen narrowing.
In the past few years several phenotypes of both obstructive diseases
have been described. They help to individualize therapy. However, some
phenotypic similarities between BA and COPD both in pathophysiology
and in clinic may suggest the 50-years-old “Dutch hypothesis” may still
remain an appealing theory.
keywords: astma, POChP, remodeling, hipoteza holenderska, asthma, COPD, remodeling, Dutch hypothesis
pages: from 11 to 15
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