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Multiple inflammatory hits and the pathogenesis of severe airway disease

Institute for Lung Health, Dept of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital, Leicester, UK.

CORRESPONDENCE: I. D. Pavord, Institute for Lung Health, Dept of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital, Leicester, LE3 9QP, UK. Fax: 44 116 2367768. E-mail: ian.pavord{at}uhl-tr.nhs.uk

Keywords: Asthma, asthma mechanisms, chronic obstructive pulmonary disease

Received: November 2, 2005
Accepted February 25, 2006

Refractory or difficult-to-control asthma is associated with some clinical and pathological features normally associated with chronic obstructive pulmonary disease (COPD), raising the possibility that there are similarities in their pathogenesis. It is suggested that the coexistence of two or more inflammatory stimuli to the airway (multiple hits) is a key factor leading to the development of more severe airway disease. Airway inflammation in response to chronic inflammatory conditions elsewhere may be a particularly important additional inflammatory stimulus. The "multiple hit" hypothesis for the origins of severe airway disease has important implications for treatment and prevention, since identification and removal of additional inflammatory stimuli may delay progression of the underlying airway disease.

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