Clinical, functional and immunological characteristics of severe bronchial asthma

Abstract

BACKGROUND: Bronchial asthma is one of the most common and socially remarkable diseases in humans. The uncontrolled course of asthma remains a leading problem in the management of patients with this disease. Patients who cannot achieve control include a special group with severe asthma. AIM: Comprehensive assessment of clinical, functional, and immunological features and the pharmacotherapy of severe bronchial asthma in real clinical practice to optimize basic pathogenetic therapy. MATERIALS AND METHODS: In all, 83 patients diagnosed with severe asthma were examined. Patients with severe asthma were divided into two groups: patients with and without fixed airway obstruction. Plasma concentrations of interleukin (IL)-4, IL-5, IL-9, IL-13, periostin, cathepsin S, and transforming growth factor (TGF)- were determined via solid-phase enzyme immunoassay. Immune status was investigated using a NAVIOS flow cytometer. RESULTS: Both groups of severe bronchial asthma patients showed a decrease in helper T-cell and immunoregulatory index levels with simultaneous increases in cytotoxic T lymphocytes, natural killer T cells, naive T lymphocytes, activated T and B lymphocytes, and phagocytic index compared with the controls. No differences were observed in the immune status between the groups, and the resulting changes were independent of the presence or absence of fixed obstruction. Both study groups exhibited increases in the levels of cathepsin S and TGF- in the plasma compared with the controls. We identified two remarkable risk factors for forming fixed obstruction: taking SABA more than four inhalations per day (odds ratio (OR)=4.2) and FeNO concentration 20 ppb (OR=6.0). A remarkable improvement was observed in the clinical condition of patients with severe asthma with fixed obstruction while receiving genetically engineered biological therapy for a year. CONCLUSIONS: To date, no unambiguous explanation is available for the mechanisms of implementation of pathobiochemical reactions in the bronchial wall in severe asthma, leading to the development of fixed airway obstruction. Severe asthma is variable and depends on the correct choice of management tactics.