Inflammation and Treatment in Asthma and COPD

By James F. Donohue, MD, FCCP; and Jill A. Ohar, MD, FCCP

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Asthma

The Dutch Hypothesis

There are important pathophysiologic similarities between asthma and chronic airflow obstruction; a predisposition is required for the development of both obstructive lung diseases. These individuals are characterized by the presence of bronchial inflammation that includes (1) increased immune atopic responses, and (2) inflammatory mediator release and cellular responses and bronchial hyperresponsiveness. Potential interactions between asthma and COPD thus include genetic susceptibility and environmental factors (eg, allergy, infection, smoking, and air pollution) leading to bronchial inflammation and bronchial hyperresponsiveness, resulting in a phenotypic expression of asthma and COPD. The Dutch hypothesis holds that genetic susceptibility and allergens lead to both asthma and COPD. In contrast, the British hypothesis states that COPD is closely related to irritant exposure and to recurrent infections.

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