BRONCHIAL ASTHMA – EMERGING THERAPEUTIC STRATEGIES Edited by Elizabeth Sapey Bronchial Asthma – Emerging Therapeutic Strategies Edited by Elizabeth Sapey Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Silvia Vlase Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Bronchial Asthma – Emerging Therapeutic Strategies, Edited by Elizabeth Sapey p. cm. ISBN 978-953-51-0140-6 Contents Preface IX Part 1 Asthma – Diagnosis, Prevalence and Progression 1 Chapter 1 The Natural History of Asthma 3 Elizabeth Sapey and Duncan Wilson Chapter 2 Bronchial Challenge Testing 19 Lutz Beckert and Kate Jones Chapter 3 Determination of Biomarkers in Exhaled Breath Condensate: A Perspective Way in Bronchial Asthma Diagnostics 37 Kamila Syslová, Petr Kačer, Marek Kuzma, Petr Novotný and Daniela Pelclová Part 2 Immunological Mechanisms in the Development and Progression of Asthma 75 Chapter 4 Immune Mechanisms of Childhood Asthma 77 T. Negoro, Y. Yamamoto, S. Shimizu, A. H. Banham, G. Roncador, H. Wakabayashi, T. Osabe, T. Yanai, H. Akiyama, K. Itabashi and Y. Nakano Chapter 5 Allergic Asthma and Aging 89 Gabriele Di Lorenzo, Danilo Di Bona, Simona La Piana, Vito Ditta and Maria Stefania Leto-Barone Chapter 6 Airway Smooth Muscle: Is There a Phenotype Associated with Asthma? 117 Gautam Damera and Reynold A. Panettieri, Jr. Chapter 7 Fluoride and Bronchial Smooth Muscle 139 Fedoua Gandia, Sonia Rouatbi, Badreddine Sriha and Zouhair Tabka VI Contents Part 3 The Management of Asthma – Emerging Treatment Strategies 147 Chapter 8 Management of Asthma in Children 149 Abdulrahman Al Frayh Chapter 9 Mechanisms of Reduced Glucocorticoid Sensitivity in Bronchial Asthma 193 Yasuhiro Matsumura Chapter 10 Antioxidant Strategies in the Treatment of Bronchial Asthma 217 Martin Joyce-Brady, William W. Cruikshank and Susan R. Doctrow Chapter 11 Rehabilitation and Its Concern 231 Ganesan Kathiresan Preface Asthma is a common, chronic and potentially debilitating disease. It is diagnosed currently on clinical grounds with a combination of symptoms (intermittent breathlessness, wheeze and cough) associated with variable airflow obstruction, which is classically reversible (by bronchodilation). The heterogeneity of asthma clinically is likely to be due to differences in the cause and the inflammatory signal present in individual groups of patients. Predisposing environmental factors (where known) vary between individuals and across countries, depending on antigenic load. However, not all patients with asthma demonstrate atopy or allergy, and other immune responses are thought important in some patient groups. It is becoming more recognised that there are specific patient phenotypes in asthma that are associated with differing patterns of disease progression, varying responses to treatment and these are likely to be driven by different genetic susceptibility factors leading to specific inflammatory outputs. Our current understanding of such factors is limited. This book focuses on emerging theories of the immunological drivers of asthma, how these relate to different patient phenotypes, and how these can be utilised to diagnose asthma more accurately and treat asthma more effectively. The editors would like to thank the authors for their contributions and we very much hope this book increases the interest in asthma research. Dr Elizabeth Sapey Centre for Translational Inflammation Research University of Birmingham United Kingdom [...]... presentation 17 References [1] Global Strategy for Asthma Management and Prevention Global Initiative for Asthma (GOLD) Available from : URL: http://www.ginaasthma.org (2006) 14 Bronchial Asthma – Emerging Therapeutic Strategies [2] National Asthma Education and Prevention Program Expert Panel Report 2 Guidelines for the daignosis and management of asthma National Institute of Health, National Heart... reduces progression to asthma although bronchodilators improve both symptoms and lung function measurements, suggesting disease is related to bronchomotor tone Sensitisation to aeroallergens is associated with a risk of chronic asthma in later life, but interestingly, 12 Bronchial Asthma – Emerging Therapeutic Strategies symptoms seem to start 2 – 3 years later than in those whose asthma is not associated... classification was often erroneously applied to 6 Bronchial Asthma – Emerging Therapeutic Strategies patients already on treatment [8] and that the usefulness of such a system was limited Severe Persistent asthma can become Mild or Intermittent Asthma if it is suitably controlled with medication, however, this change in severity classification may not reflect the severity of asthma present initially, nor the difficulty... population in different countries [17] Data suggest that there are increases in prevalence of asthma in children and in older adults in developing countries and decreases in the prevalence of 8 Bronchial Asthma – Emerging Therapeutic Strategies asthma in the developed world [18] Urbanisation appears to be a risk factor for asthma, as its prevalence has consistently been shown to be higher among children living... wheezy bronchitis and asthma in children An epidemiological study BMJ 4(5679), 321 - 325 (1969) [65] Phelan PD Asthma in children and adolescents: An overview London: Balliere Tindall (1995) 18 Bronchial Asthma – Emerging Therapeutic Strategies [66] Fabbri LM, Romagnoli M, Corbetta L, Et Al Differences in airway inflammation in patients with fixed airflow obstruction due to asthma or chronic obstructive... BN, Ray A, Hylkema MN, Timens W, Postma DS Are there reasons why adult asthma is more common in females? Curr Allergy Asthma Rep 7, 143 - 150 (2007) [33] Taylor WR, Newacheck PW Impact of childhood asthma on health Pediatrics 90, 657 662 (1992) 16 Bronchial Asthma – Emerging Therapeutic Strategies [34] Coultras DB, Gong HJ, Grad R, Et Al Respiratory diseases in minorities of the United States Am J Respir... the lengths of taking bronchial 26 Bronchial Asthma – Emerging Therapeutic Strategies biopsies to show the absence of inflammation but there is still evidence of airway remodelling and increased mucus production The clinical implications are wide; it raised the possibility of airway remodelling secondary to airway injury after a chronic cough and the importance of addressing bronchial constriction... unabated (the natural course of the disease), or disease-modifying strategies can be employed to protect or reduce disease presentation, or to affect a cure See figure 2 for a diagrammatic representation of this Fig 2 A hypothetical representation of the course of a chronic disease (adapted from [37]) 10 Bronchial Asthma – Emerging Therapeutic Strategies The prodromal stage equates to disease predisposition... reversibility suggestive of asthma is achieved with a change in the FEV1 of 400ml (NICE COPD guidelines 2010) Many studies have investigated the appropriate cut-off for significant reversibility The choice of cut-points needs to balance the chance of an event occurring by random variation; the co-efficient of variant of the measurement has its upper 22 Bronchial Asthma – Emerging Therapeutic Strategies limits... associated with widespread but variable airflow obstruction within the lung that is often reversible either spontaneously or with treatment” [1] 4 Bronchial Asthma – Emerging Therapeutic Strategies In keeping with current theories, this definition implies that asthma is one disorder, rather than multiple complex disorders and syndromes [3] without detracting from its variable clinical presentation and . BRONCHIAL ASTHMA – EMERGING THERAPEUTIC STRATEGIES Edited by Elizabeth Sapey Bronchial Asthma – Emerging Therapeutic Strategies Edited by Elizabeth. orders@intechweb.org Bronchial Asthma – Emerging Therapeutic Strategies, Edited by Elizabeth Sapey p. cm. ISBN 978-953-51-0140-6 Contents Preface IX Part 1 Asthma – Diagnosis,. decreases in the prevalence of Bronchial Asthma – Emerging Therapeutic Strategies 8 asthma in the developed world [18]. Urbanisation appears to be a risk factor for asthma, as its prevalence