Inhaled corticosteroids in asthma : effects on inflammation and lung function
(Inhalatiecorticosteroiden bij astma: Effecten op ontsteking en longfunctie)
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Many clinicians are frequently confronted with an adolescent who comes to the first aid department in the middle of the night, complaining of breathlessness and chest tightness. While he was in a smoky environment he became wheezy and felt out of breath. After taking some bronchodilator puffs his complaints did not improve but got even worse. Others are more familiar with the picture of the infant, out of breath sitting on the bench during gymnastics whereas other kids are busy doing their exercises. All clinicians will immediately recognize the clinical symptoms of an asthma patient. Bul what exactly is going on wilhin the airways? Asthma is one of the most common disorders, affecting approximately 10% of the population in the Western countries. Asthma, was used to describe several disorders characterized by breathlessness or pain in the chest. Sir John Floyer wrote in his "treatise of the asthma" in 1698: "I have assigned the immediate cause of asthma to the straitness, compression, or constriction of the bronchi". Laennec in the eighteenth century attributed asthma to a spasm of the smooth muscle fibers of the bronchi. In spite of the fact that our knowledge of the disease has increased since then and asthma is now considered as a chronic inflammatory disease, we still do not know the fundamental cause of asthma and all the factors that induce airway inflammation. Airway inflammation in asthma is characterized by redness and swelling of the mucosa. These classical signs of inflammation are easily visible at bronchoscopic examination. Bronchial biopsies not only show activated mast cells, eosinophils and lymphocytes, but also epithelial shedding and fragility. Structural changes include hypertrophy and hyperplasia of airway smooth muscle, and thickening of the basement mem-brane due to the deposition of collagen in the lamina reticularisb.