About this Research Topic
Respiratory chronic disorders are common inflammatory diseases including bronchial asthma and chronic obstructive pulmonary disease (COPD), characterized by airflow limitation, cough, dyspnea, chest tightness, shortness of breath, and mucus production. Since they are very complex and heterogeneous disorders their clinical evolution, as well as their treatment, are often not predictable.
The World Health Organization (WHO) defines asthma as the most common chronic disease in children, with an estimation of more than 300 million people affected. On the other hand, with nearly 329 million people affected, COPD has been identified as the third leading cause of death worldwide. From a clinical point of view, since these two disorders share several characteristics such as inflammation and a chronic, progressively reduced lung function, they are often undistinguishable, except for the evidence that, unlike asthma, COPD is often irreversible and more common among the elderly. Allergic mechanisms have been implicated in 50-80% of asthmatic patients and in approximately 50% of severe asthma. This is one of the reasons why asthma has usually been associated with type 2 respiratory inflammation, characterized by high levels of IgE, eosinophils and some cytokines such as IL4, IL5, IL13 and IL9, canonically associated with allergic responses. In contrast, COPD pathogenesis has been related with chronic exposure to cigarette smoke that can elicit neutrophil retention within the airways, being the neutrophilia degree associated with severity, exacerbations, disease progression, and treatment resistance. However, there are also many clinical conditions where there is a mixture of inflammatory cells (eosinophils/neutrophils), without a clear type 1 or 2 respiratory inflammation and entities like ACOS (Asthma-COPD Overlap Syndrome) were COPD and asthma are not easily diagnosed and/or treated.
The main problem of complex respiratory diseases is their broad clinical spectrum, as they can be caused by multiple genetic, pharmacological, physiological, biological and/or immunological mechanisms, giving rise to subclasses of phenotypes and endotypes. This great heterogeneity has motivated the attempt to use precision or personalized medicine, which requires different diagnostic and therapeutic approaches. In this respect, the use of a system biology approach, that treats the disease as a holistic process without any targeted hypothesis, combined with multiple studies derived from –omics technologies, mainly transcriptomic, genomic and proteomic, has been fruitfully used in the last years in other medical fields (especially in cancer), in order to develop a new molecular medicine.
In this Research Topic we aim to provide an overview of the latest studies in the field of system biology investigating immunological and other mechanisms leading to chronic respiratory diseases. These will involve the use of genomic, epigenomic, proteomic and metabolomic studies for the definition of new endotypes, or to discover and validate potential biomarkers related with diagnosis, prognosis, exacerbations, theragnostics, and treatment monitoring. Such advances might also allow to detect suitable molecular targets for biological therapies, which are especially useful for add-on treatment of severe asthma. Therefore, relevant progresses in basic research are essential for a “bench-to-bedside” strategy, aimed to provide novel and better therapeutic tools for patients suffering from chronic obstructive respiratory diseases.
We welcome Original Research, Review and Methods articles covering the following topics:
- Immunological mechanisms, including inflammatory responses, in complex respiratory diseases.
- Identification of potential biomarkers for the treatment of asthma and COPD.
- Omics technologies in the clinical management of asthma and respiratory allergic diseases.
Keywords: Asthma, chronic obstructive pulmonary disease, COPD, respiratory inflammation, system biology, biological therapies
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