Eosinophil Progenitors in Airway Diseases: Diagnostic and Therapeutic Considerations

Systemic vs Local Therapy

The knowledge that systemic inflammation occurs in conditions where the inflammation is primarily localized to the respiratory tract has led to debate as to whether it is necessary to treat these conditions systemically or whether local treatment is sufficient; in this discussion, it is not precluded that local treatment may have some beneficial (direct or indirect) systemic effects. The type of inflammation locally also may determine choice of therapy. The development of induced sputum and nasal lavage to measure the type of inflammation locally present has helped to better understand the type of treatment necessary both at the time of exacerbation and during long term treatment.

Treatment of Allergic Rhinitis

It is possible that optimal treatment of allergic rhinitis not only may improve coexisting asthma but also potentially postpone or prevent its development, although this remains to be examined. Up to now, inhaled and nasal CS are widely recognized to be effective antiinflammatory treatments for both asthma and rhinitis. Inhaled CS act at various sites of the inflammatory process, particularly in reducing inflammatory cells and release of mediators.

While intranasal steroids can improve lower airway hyperresponsiveness, a greater benefit is seen in patients with both allergic rhinitis and asthma if topical steroids are delivered to both sites of inflam-mation. Of less remarkable but still significant clinical benefit, working through a different pathway, montelukast, a specific leukotriene receptor antagonist (LTRA), has been shown to reduce allergic rhinitis and asthma symptoms. Cysteinyl leuko-trienes (CysLTs) are potent receptor agonist mediators capable of inducing cell recruitment and bronchospasm, increased vascular permeability, and nasal airway resistance. Montelukast antagonizes these effects and thus attenuates the allergen-induced early and late asthmatic responses. It also reduces sputum eosinophilia following allergen challenge. Since CysLT receptors are expressed on hemopoietic progenitors, antagonism with montelukast may attenuate tissue eosinophilia via a systemic antiinflammatory effect.

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