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Review
. 2013 Mar-Apr;20(2):117-20.
doi: 10.1155/2013/602936.

Update on clinical inflammometry for the management of airway diseases

Parameswaran Nair  1
Affiliations
Review

Update on clinical inflammometry for the management of airway diseases

Parameswaran Nair. Can Respir J. 2013 Mar-Apr.

Abstract
in English, French

Airway inflammation is a central feature of many airway diseases such as asthma, chronic bronchitis, bronchiectasis and chronic cough; therefore, it is only logical that it is measured to optimize its treatment. However, most treatment recommendations, including the use of anti-inflammatory therapies such as corticosteroids, are based on assessments of only airflow and symptoms. Over the past 10 years, methods have been developed to assess airway inflammation relatively noninvasively. Quantitative cell counts in sputum and the fraction of exhaled nitric oxide are the most validated tests. Judicious use of currently available drugs, such as corticosteroids, bronchodilators and antibiotics, and other anti-inflammatory therapies guided by sputum eosinophil and neutrophil counts, have been demonstrated to decrease exacerbations of asthma and chronic obstructive pulmonary disease, ameliorate cough, improve quality of life in patients with these diseases and is cost effective compared with treatment strategies based on guidelines that do not incorporate these measurements. Thus, it is unfortunate that this is not used more widely in the management of airway diseases, particularly in patients with severe asthma and chronic obstructive pulmonary disease who experience frequent exacerbations.

L’inflammation des voies respiratoires est un élément central de nom-breuses maladies des voies respiratoires comme l’asthme, la bronchite chronique, la bronchiectasie et la toux chronique. Par conséquent, il est logique de la mesurer pour en optimiser le traitement. Cependant, la plu-part des recommandations thérapeutiques, y compris le recours à des traite-ments anti-inflammatoires comme les corticoïdes, se fondent sur des évaluations limitées au débit respiratoire et aux symptômes. Depuis dix ans, des méthodes ont été mises au point pour évaluer l’inflammation des voies respiratoires de manière relativement non envahissante. Le dénombrement cellulaire quantitatif dans les expectorations et la fraction de monoxyde d’azote exhalé sont les tests les plus validés. Il est démontré qu’une utilisation judicieuse des médicaments sur le marché, tels que les corticoïdes, les bronchodilatateurs et les antibiotiques, et d’autres traitements anti-inflammatoires sélectionnés selon la numération des éosinophiles et des neutrophiles dans les expectorations, réduit les exacerbations d’asthme et de maladie pulmonaire obstructive chronique, limite la toux, améliore la qualité de vie chez les patients atteints de ces maladies et est rentable par rapport à des stratégies thérapeutiques fondées sur des lignes directrices qui n’intègrent pas ces mesures. Il est donc malheureux qu’on ne l’utilise pas de manière plus généralisée pour traiter les maladies des voies respiratoires, notamment chez les patients atteints d’asthme grave et de maladie pulmo-naire obstructive chronique qui présentent de fréquentes exacerbations.

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