Team finds new type of severe asthma, can be treated with drugs that suppress the immune system

July 19, 2012

(Medical Xpress) -- Researchers at the University of Pittsburgh School of Medicine have identified a subset of severe asthma that improves with drug regimens that suppress the immune system. In the American Journal of Respiratory and Critical Care Medicine, they dubbed the condition “asthmatic granulomatosis” after the characteristic small areas of focal inflammation that can be found in the lungs of those who have it.

Five to 10 percent of with asthma have disease that can be classified as severe, meaning it is difficult to treat and often causes life-threatening breathing problems, said lead author Sally E. Wenzel, M.D., professor, Division of Pulmonary, Allergy and Medicine, Pitt School of Medicine, and director of the University of Pittsburgh Asthma Institute at UPMC and the University of Pittsburgh School of Medicine. Typically these patients are treated with the aim of reducing lung inflammation, but treatment often leads to devastating consequences due to steroid side effects.
“We’re now learning that all severe asthma is not the same, but is in fact the result of different problems,” she said. “If we better understand the underlying mechanisms that are causing the symptoms, we can offer better treatments.”
For the study, the team examined a group of patients with severe asthma who were being treated at the Difficult Asthma Clinic at the UPMC Comprehensive Lung Center during a four-year period. Each of the patients met with a certified asthma educator; were taking high doses of inhaled steroids, with or without ingested steroids; and had been monitored for three to 24 months to optimize therapy.
Nineteen patients then underwent biopsies of their lung tissue using a video-assisted, fiberoptic scope. Ten of them not only had airway changes typical of asthma, but also lesions called granulomas, which are nodules of inflammation sometimes seen with certain infections or with autoimmune diseases. None of the patients had a history of hypersensitivity pneumonitis, an acute illness caused by inhalation of foreign particles such as dust, molds and fungi, which can also lead to granuloma formation.
However, 70 percent of the patients had a personal or family history of autoimmune-like disease such as lupus and rheumatoid arthritis. Because granulomas can be produced by an over-active , the team treated the 10 cases with drugs that suppress it, including azathioprine, mycophenolic acid, methotrexate or infliximab. Nine of them reduced their steroid doses and had improvements in standard lung-function tests while one has experienced difficulty tolerating the powerful immune-suppressants.
Of the other nine patients who had biopsies, six had tissue changes that reflected asthma, but no granulomas, and three had other issues, including indications of aspiration, pneumonia and small blood clots.
“The unexpected finding of granulomas in a subset of patients with warrants approaching it as a newly described disease, which we’ve named asthmatic granulomatosis,” Dr. Wenzel said. “It is a condition that has overlapping features of asthma, autoimmunity and granulomas, and it appears to respond better to immune-suppressants than to high-dose steroid treatment.”
specialists should consider getting tissue biopsies in atypical severe asthmatics, the researchers said. More research is needed to determine the immunological pathways that contribute to the disease and develop biomarkers that will simplify diagnosis of asthmatic granulomatosis, they added.
“These studies advance our division’s focus on precision, or personalized, medicine -- an effort to better refine specific patient diagnoses and tailor more effective therapies,” said Dr. Mark T. Gladwin, chief of the Pulmonary, Allergy and Division.

Explore further: Discovery of asthma cause could help treat sufferers

Related Stories

Discovery of asthma cause could help treat sufferers

October 5, 2011
(Medical Xpress) -- Scientists at the University of Bath have found a new cause of severe asthma that could help develop a treatment and potentially prevent the 1100 asthma deaths each year in the UK.

Researchers study biofeedback for asthma

November 22, 2011
National Jewish Health researchers are delving into the biology of biofeedback to understand how it helps asthma patients and what role it could play in reducing medication use for the chronic lung disease. In a study funded ...

Researchers find molecular pathway that leads to inflammation in asthma

August 8, 2011
Researchers at the University of Pittsburgh School of Medicine have identified a molecular pathway that helps explain how an enzyme elevated in asthma patients can lead to increased mucus production and inflammation that ...

Hot, Humid Weather Could Affect Asthma Sufferers

July 21, 2011
The Tristate has experienced a stint of heat waves this summer which have not only included high temperatures but also high humidity that has made the air feel like a perpetual sauna.

Depressive symptoms may make asthma control more difficult

October 26, 2011
(Medical Xpress) -- People with asthma are more likely to have symptoms of depression. A new study suggests these symptoms are linked to a host of other negative health risks that may lead to a worsening of asthma symptoms ...

Recommended for you

Genetic immune deficiency could hold key to severe childhood infections

July 18, 2017
A gene mutation making young children extremely vulnerable to common viruses may represent a new type of immunodeficiency, according to a University of Queensland researcher.

What are the best ways to diagnose and manage asthma?

July 18, 2017
What are the best ways to diagnose and manage asthma in adults? This can be tricky because asthma can stem from several causes and treatment often depends on what is triggering the asthma.

Large multi-ethnic study identifies many new genetic markers for lupus

July 17, 2017
Scientists from an international consortium have identified a large number of new genetic markers that predispose individuals to lupus.

Study finds molecular explanation for struggles of obese asthmatics

July 17, 2017
A large, bouquet-shaped molecule called surfactant protein A, or SP-A, may explain why obese asthma patients have harder-to-treat symptoms than their lean and overweight counterparts, according to a new study led by scientists ...

Team identifies potential cause for lupus

July 14, 2017
Leading rheumatologist and Feinstein Institute for Medical Research Professor Betty Diamond, MD, may have identified a protein as a cause for the adverse reaction of the immune system in patients suffering from lupus. A better ...

Immunosuppression underlies resistance to anti-angiogenic therapy

July 14, 2017
A Massachusetts General Hospital (MGH) research team has identified a novel mechanism behind resistance to angiogenesis inhibitors - drugs that fight cancer by suppressing the formation of new blood vessels. In their report ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.