The Role of Noninvasive Measurement of Airway Inflammation in Asthma and Chronic Obstructive Pulmonary Disease

US Respiratory & Pulmonary Diseases, 2016;1(1):30–4 DOI:


Over the past few decades, a great emphasis has been put into developing and researching noninvasive techniques for monitoring respiratory functions in those with airway inflammatory diseases via biomarkers. The three most promising methods currently being researched are induced sputum analysis, exhaled nitric oxide measurement, and exhaled breath condensate analysis. Clinical applications of these three methods have the potential to transform the way we diagnose, monitor, and ultimately treat those with a variety of airway inflammatory diseases, such as asthma and chronic obstructive pulmonary disease (COPD). The rise in research into noninvasive airway biomonitoring is due to several factors. The ease of administering these tests compared with more invasive procedures, such as the bronchoalveolar lavage, enables physicians to more closely and effectively monitor airway inflammation in their patients, especially in vulnerable populations (children, aging, developing countries) that are not only more likely to suffer from these chronic respiratory diseases but also prove harder to perform invasive medical procedures on. In addition, there is an increasing goal of subclassifying different molecular and inflammatory phenotypes within these diseases, leading to more personalized therapies based on the specific composition of the inflammation. We present here the current understanding of biomarkers in these three techniques regarding asthma and COPD as well as the overall importance of determining airway inflammation composition.
Keywords: Noninvasive airway monitoring, airway inflammation, asthma, COPD, induced sputum, exhaled nitric oxide, exhaled breath condensate, vulnerable populations, multiple biomarker profile
Disclosure: Joseph Mizrahi and Elizabeth Fireman have nothing to disclose in relation to this manuscript. No funding was received in the publication of this article.
Received: September 15, 2015 Accepted October 09, 2015
Correspondence: Joseph Mizrahi, Sackler School of Medicine, 17 East 62nd Street, New York, New York 10065, US. E:
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit.

Airway inflammatory diseases are assessed and managed via multiple measurements, including airway caliber, airway responsiveness, and airway inflammation. Exacerbations post diagnosis is also a critical marker in terms of disease status and progression. Currently, diagnosis and monitoring of asthma1 and chronic obstructive pulmonary disease2 (COPD) is based largely on symptom reporting, pulmonary function tests, and bronchial reactivity. However, besides the inherent problems of subjective symptom reporting, it turns out that symptoms and lung function tests do not necessarily reflect the underlying airway inflammation in patients suffering from these diseases.3

While this association between asthma and COPD, and airway inflammation, has been well established, it is only recently that the actual composition of the inflammation (and not merely the presence of inflammation) has been studied in terms of determining the exact pathophysiology of these diseases, as well as to monitor disease progression and treatment.4 For example, with regard to asthma, the degree of eosinophilic airway inflammation has not only been shown to correlate with airway responsiveness, but in fact targeting airway eosinophilia specifically has consistently been associated with fewer asthmatic exacerbations, fewer hospitalizations, and fewer symptoms.5,6 Moreover, the diagnosis of eosinophilic inflammation is more closely associated with a positive response to inhaled corticosteroids (ICS) than any other clinical measure, and thus the presence and degree of airway eosinophilia is critical in assessing one’s possible response to ICS as well as altering ICS doses once treatment begins.4

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Keywords: Noninvasive airway monitoring, airway inflammation, asthma, COPD, induced sputum, exhaled nitric oxide, exhaled breath condensate, vulnerable populations, multiple biomarker profile