Lung attacks in children with severe asthma: the role of mast cells
Lung attacks usually describe pulmonary exacerbations in cystic fibrosis. Recently, this definition has been used also in asthmatic disease.
When lung attacks occur in the asthmatic patient they are associated with a rapid decline of spirometric values and are a strong predictor of asthma death. In order to prevent lung attacks, clinicians have to recognize that the many factors can predict loss of control such as failure to attend follow-up appointments, overuse of short-acting β2-agonists, underuse of ICS or the combination of a viral infection with the exposure to allergens in a sensitized subject.
However, it is not always possible to predict exacerbations in a patient with asthma because we all know that the pathophysiological mechanisms underlying the disease can be very different.
The authors of this editorial refer to an article published in the same issue of the ERJ where Lezmi et al. report that in addition to the known eosinophilic inflammation, the bronchial mucosa of children with severe asthma showed also large quantities of mast cells (Lezmi G 2016). These new data may help to better describe the inflammatory pattern of children with severe asthma but the presence of mast cells in the airways cannot be the key factor to predict lung attacks because they are only a piece of a bigger and more complex picture. After an exacerbation the patient with asthma has to be globally re-evaluated (adherence to therapy, presence of comorbidities, environmental and life-style issues) because the exacerbation is a clear sign of the failure of the preventive therapy and the clinician has to find and understand the reasons that caused it. Only when we will discover non-invasive biomarkers describing the risk, the onset and the termination of asthma attack we will be able to prevent it.
Fleming L, Saglani S, Bush A. Asthma attacks: should we nail our colours to the mast (cell)? Eur Respir J. 2016 Nov;48(5):1261-1264
Lezmi G, Galmiche-Rolland L, Rioux S, et al. Mast cells are associated with exacerbations and eosinophilia in children with severe asthma. Eur Respir J 2016; 48: 1320–1328