Περίληψη:
The term bronchial hyperresponsiveness is generally used to describe a
heightened airway smooth muscle bronchoconstrictor response measured by
bronchoprovocation testing. However, the airway also responds to
inflammation or bronchoprovocation with increased mucus secretion. We
use the term “secretory hyperresponsiveness” to mean increased mucus
secretion either intrinsically or in response to bronchoprovocation.
This is not the same as retained phlegm or sputum. Unlike smooth muscle
contraction, which is rapidly reversible using a bronchodilator, mucus
hypersecretion produces airflow limitation that reverses more slowly and
depends upon secretion clearance from the airway. Certain groups of
patients appear to have greater mucus secretory response, including
those with middle lobe syndrome, cough-dominant (”cough-variant”)
asthma, and severe asthma. Secretory hyperresponsiveness also is a
component of forms of lung cancer associated with bronchorrhea. An
extreme form of secretory hyperresponsiveness may lead to plastic
bronchitis, a disease characterized by rigid branching mucus casts that
obstruct the airway. Secretory hyperresponsiveness and mucus
hypersecretion appear to be related to activation of the
extracellular-regulated kinase 1/2, signaling through the epidermal
growth factor receptor, or secretory phospholipases A2. Recognizing
secretory hyperresponsiveness as a distinct clinical entity may lead to
more effective and targeted therapy for these diseases.
Συγγραφείς:
Rubin, Bruce K.
Priftis, Kostas N.
Schmidt, H. Joel
Henke,
Markus O.
