Airway Inflammation in Asthma Non-invasive Assessment in Clinical Practice

Airway Inflammation in Asthma Non-invasive Assessment in Clinical Practice

Charlotte Suppli Ulrik
European Respiratory Disease 2007 - Issue I
Published: October 2008
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Asthma is an inflammatory airway disease for which disease activity assessment is often based on symptoms, lung function and use of reliever medication. It would be helpful to include non-invasive measuring of airway inflammation in the assessment of disease activity to guide therapy. This short review outlines some of the methods for assessing airway inflammation that are potentially useful in clinical practice.

Airway inflammation is probably the most important component of asthma. In spite of that, monitoring of disease activity in asthma often relies on a combination of frequency and severity of symptoms, use of reliever medication and level of lung function, assessed according to guidelines.1 However, assessment of symptoms and lung function may not be a reliable marker of the degree of airway inflammation in patients with asthma.2,3 Failing to obtain further, and sufficient, information with regard to airway inflammation may put the patients at risk of progressive airway remodelling – particularly in patients with more severe asthma – which may lead to nonreversible airflow obstruction.4 Direct measurement of airway inflammation will therefore be beneficial for guiding therapy in patients with asthma, especially for those in specialist care where the disease is often more complicated and difficult to control. This short review outlines some of the methods for assessing airway inflammation that have, or have almost, reached clinical practice.

Airway Hyperresponsiveness
Airway hyperresponsiveness (AHR) may be defined as an increase in the degree of airflow limitation in response to bronchoconstrictor stimuli. These bronchoconstrictor stimuli can be classified, according to the main mechanism through which they trigger airflow limitation, as direct and indirect (see Table 1).5

Table 1: Classification of Bronchoconstrictor Agents used for Challenge Tests
Bronchoconstrictor Agents
AMP = adenosine monophosphate


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