Imbalanced Coagulation in the Airway of Type-2 High Asthma with Comorbid Obesity.
Imbalanced Coagulation in the Airway of Type-2 High Asthma with Comorbid Obesity.
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DOI：
10.2147/jaa.s318017
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发表时间：
2021
影响因子：
3.2
通讯作者：
Ingram JL
中科院分区：
文献类型：
--
作者：
Womble JT;McQuade VL;Ihrie MD;Ingram JL
哮喘是一种常见的慢性气道炎症性疾病，其特征是气道高反应性、炎症和重塑。在过去的几十年里，哮喘发病率迅速增加，最近的多中心分析揭示了几种独特的哮喘内型。其中，2型高哮喘合并肥胖是一种独特的临床挑战，其特点是对标准治疗的耐药性增加，疾病发展加剧。外源性凝血途径在2型高哮喘和肥胖中都起着重要作用。2型高哮喘气道的特点是促凝剂电位升高，在气道组织损伤后极易激活。在这篇综述中，我们总结了目前对外源性凝血途径在2型高哮喘合并肥胖患者气道中的作用的理解。我们认为肥胖导致哮喘控制恶化，这是由于全身和局部气道向促凝剂和抗纤溶环境转移的结果。最后，我们假设减肥手术可以改善2型高哮喘合并肥胖患者的哮喘管理，促进全身促凝剂和促炎介质的正常化。更好地了解减肥手术后气道内凝血参数的减弱，将提高我们对肥胖患者哮喘病理生物学生物分子途径的认识。
Asthma is a common, chronic airway inflammatory disease marked by airway hyperresponsiveness, inflammation, and remodeling. Asthma incidence has increased rapidly in the past few decades and recent multicenter analyses have revealed several unique asthma endotypes. Of these, type-2 high asthma with comorbid obesity presents a unique clinical challenge marked by increased resistance to standard therapies and exacerbated disease development. The extrinsic coagulation pathway plays a significant role in both type-2 high asthma and obesity. The type-2 high asthma airway is marked by increased procoagulant potential, which is readily activated following damage to airway tissue. In this review, we summarize the current understanding of the role the extrinsic coagulation pathway plays in the airway of type-2 high asthma with comorbid obesity. We propose that asthma control is worsened in obesity as a result of a systemic and local airway shift towards a procoagulant and anti-fibrinolytic environment. Lastly, we hypothesize bariatric surgery as a treatment for improved asthma management in type-2 high asthma with comorbid obesity, facilitated by normalization of systemic procoagulant and pro-inflammatory mediators. A better understanding of attenuated coagulation parameters in the airway following bariatric surgery will advance our knowledge of biomolecular pathways driving asthma pathobiology in patients with obesity.