Airwaves
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As Turato and colleagues point out in their editorial in this month’s Thorax, prevention of exacerbations has been the goal of most therapeutic interventions for the management of asthma. However, despite extensive investigation of inflammatory processes in stable disease, little is know about inflammation at exacerbations, particularly when severe. In this issue Qiu and colleagues present for the first time a study of inflammation in bronchial biopsies, taken from patients intubated for severe exacerbations of asthma. The authors found that there was an increase of airway eosinophils and neutrophils in asthmatic exacerbations compared with controls and there were increases in a number of chemokines (see figure). They also found an interesting correlation between CXCL5 and its receptor CXCR2 and eosinophilia in the biopsies at exacerbation. These changes are distinct from chronic obstructive pulmonary disease (COPD) where neutrophils are predominant at exacerbation while in asthmatic exacerbations similar numbers of both
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