Features of inflammation in severe bronchial asthma

Aim. To evaluate the characteristics of inflammation in severe bronchial asthma in real-world clinical practice, using the city of Krasnoyarsk as an example.
Materials and methods. Eighty patients diagnosed with severe bronchial asthma were examined. Prior to enrollment, all patients had been receiving standard maintenance therapy corresponding to steps 4–5 according to the Russian federal clinical guidelines and exhibited uncontrolled asthma. The general clinical assessment included patient interviews, physical examination, and review of outpatient medical records and hospital discharge summaries. Pulmonary function tests were performed using a whole-body plethysmograph (Erich Eger, Germany). Serum levels of total IgE, interleukins (IL)-5, IL-4, IL-10, IL-9, IL-13, transforming growth factor beta (TGF-β), periostin, cathepsin S, and dipeptidyl peptidase-4 (DPP-4) were measured by solid-phase enzyme-linked immunosorbent assay (ELISA). Fractional exhaled nitric oxide (FeNO) was assessed using the portable analyzer «NObreath» (Bedfont Scientific Limited, UK).
Results. Fixed airflow obstruction (FAO) was present in 58% of patients with severe bronchial asthma. Evaluation of T2 inflammation biomarkers revealed that one marker was elevated in 15 (18.7%) patients, two markers in 34 (42.5%), and three markers in 31 (38.7%) patients. In one-third of patients with severe asthma, three T2 biomarkers were simultaneously elevated, which was associated with significantly higher peripheral blood eosinophil counts, total IgE levels, and FeNO values—although no corresponding increase in cytokine levels was observed. Compared to healthy controls, patients with severe asthma demonstrated significantly elevated concentrations of T2-associated cytokines (IL-4, IL-5, IL-13), as well as cathepsin S, periostin, and TGF-β. Notably, plasma periostin levels were significantly higher in patients with severe asthma and FAO compared to both those without FAO and healthy controls (p = 0.034). Correlation analysis revealed moderate-strength associations between cathepsin S, TGF-β, and DPP-4 levels and T2 cytokines. Furthermore, cathepsin S, TGF-β, DPP-4, and periostin were interrelated and correlated with lung function parameters.
Conclusion. Activation of three T2 inflammatory signaling pathways is associated with markedly elevated FeNO, blood eosinophils, and total IgE. A significant increase in plasma periostin levels in patients with severe asthma and fixed airflow obstruction suggests its potential role in T2 inflammation and airway remodeling.

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