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Asthma is a common pulmonary condition defined by chronic inflammation of respiratory tubes, tightening of respiratory smooth muscle, and episodes of bronchoconstriction. [1] The Centers for Disease Control and Prevention estimate that 1 in 11 children and 1 in 12 adults have asthma in the United States of America. [ 1 ]
Airway remodelling is a multifaceted process involving multiple airway tissues. These include goblet cell hyperplasia, leading to increased mucus production, and airway smooth muscle hypertrophy (or smooth muscle cell hyperplasia), leading to the release of pro-inflammatory and pro-fibrotic messengers contributing to subepithelial fibrosis.
Asthma phenotyping and endotyping has emerged as a novel approach to asthma classification inspired by precision medicine which separates the clinical presentations of asthma, or asthma phenotypes, from their underlying causes, or asthma endotypes. The best-supported endotypic distinction is the type 2-high/type 2-low distinction.
The respiratory bronchioles deliver air to the exchange surfaces of the lungs. [5] They are interrupted by alveoli which are thin walled evaginations. Alveolar ducts are side branches of the respiratory bronchioles. The respiratory bronchioles are lined by ciliated cuboidal epithelium along with some non-ciliated cells called club cells. [6]
The lower airways or lower respiratory tract includes the portion of the larynx below the vocal folds, trachea, bronchi and bronchioles. The lungs can be included in the lower respiratory tract or as separate entity and include the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli. [3] Adult and pediatric airway anatomy
The cells in the respiratory epithelium are of five main types: a) ciliated cells, b) goblet cells, c) brush cells, d) airway basal cells, and e) small granule cells (NDES) [6] Goblet cells become increasingly fewer further down the respiratory tree until they are absent in the terminal bronchioles; club cells take over their role to some extent here. [7]
It might be expected that people with EIB would present with shortness of breath, and/or an elevated respiratory rate and wheezing, consistent with an asthma attack. However, many will present with decreased stamina, or difficulty in recovering from exertion compared to team members, or paroxysmal coughing from an irritable airway. [2]
Pulmonary drug delivery is mainly utilized for topical applications in the lungs, such as the use of inhaled beta-agonists, corticosteroids and anticholinergic agents for the treatment of asthma and COPD, the use of inhaled mucolytics and antibiotics for the treatment of cystic fibrosis (CT) and respiratory viral infections, [1] and the use of inhaled prostacyclin analogs for the treatment of ...