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Airway inflammation in COPD- progress to precision medicine

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journal contribution
posted on 01.05.2019, 15:12 by Christopher Brightling, Neil Greening
Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide and its prevalence is increasing. Airway inflammation is a consistent feature of COPD and is implicated in the pathogenesis and progression of COPD, but anti-inflammatory therapy is not first line treatment. This inflammation has many guises and phenotyping this heterogeneity has revealed different patterns. Neutrophil-associated COPD with activation of the inflammasome, T1 and T17 immunity is the most common phenotype with eosinophil-associated T2-mediated immunity in a minority and autoimmunity observed in more severe disease. Biomarkers have enabled targeted anti-inflammatory strategies and revealed that corticosteroids are most effective in those with evidence of eosinophilic inflammation. Whereas in contrast to severe asthma response to anti-IL5 biologics in COPD has been disappointing with smaller benefits for the same intensity of eosinophilic inflammation questioning its role in COPD. Biological therapies beyond T2-mediated inflammation have not demonstrated benefit and in some cases increased risk of infection suggesting that neutrophilic inflammation and inflammasome activation might be largely driven by bacterial colonisation and dysbiosis. Herein we shall describe current and future biomarker approaches to assess inflammation in COPD and how this might reveal tractable approaches to precision medicine and unmask important host-environment interactions leading to airway inflammation.

Funding

Dr Neil J Greening- Dr Greening is funded by a NIHR post-doctoral fellowship (PDF-2017- 19 10-052)

History

Citation

European Respiratory Journal, 2019

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation

Version

AM (Accepted Manuscript)

Published in

European Respiratory Journal

Publisher

European Respiratory Society

issn

0903-1936

Acceptance date

24/04/2019

Copyright date

2019

Publisher version

https://erj.ersjournals.com/content/early/2019/05/01/13993003.00651-2019.abstract

Notes

The file associated with this record is under embargo until 18 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en