Two respiratory diseases share the same inflammatory profile

New research led by the Murdoch Children’s Research Institute (MCRI) has revealed how two chronic respiratory diseases in childhood affect the immune system, finding that suppurative lung disease and wheezing have the same inflammatory profile despite their differing symptoms. While these two diseases are common in children, a poor understanding of the underlying mechanisms means that treatment options are currently limited and disease recurrence is commonplace.

Preschool asthma/recurrent wheeze is a leading cause of hospital admissions and results in poor lung function that persists for decades, while suppurative lung diseases span a range of lung diseases characterised by chronic cough, airway obstruction and poor long-term health. As noted by MCRI’s Dr Shivanthan Shanthikumar, children with chronic respiratory diseases have simply not benefited from advances in care as much as adults with such conditions.

“Currently, management of these conditions in children is lacking, particularly for chronic cough which relies on prolonged antibiotic use despite evidence they’re not very effective,” Shanthikumar said. Recurrent courses of antibiotics for such a highly prevalent condition are of significant concern, with antimicrobial resistance being a leading public health threat.

“But we can better manage chronic respiratory diseases if we can identify and target inflammatory profiles which underlie these serious health conditions.”

The new study involved 93 children who had lung fluid and blood samples taken at The Royal Children’s Hospital, and found two treatable endotypes (disease subtypes) that were similar in frequency and immune signature across both respiratory diseases. MCRI’s Dr Melanie Neeland said this discovery — published in the journal Mucosal Immunology — was measurable in a clinical setting via a lung sample and, if validated in future studies, has the potential to change clinical management.

“The findings provide a significant advance in our understanding of lung inflammation in children with wheeze and suppurative lung disease,” she said.

“We showed that while the clinical presentations of these two diseases are different, identical inflammatory profiles can be found in the lungs and therefore the same anti-inflammatory treatments could be effective against both.

“Importantly, about 50% of children in each disease group showed a hyper-inflammatory response that could potentially be treated with therapies already approved for use in children.

“Targeted anti-inflammatory treatments, such as repurposing asthma biologic medication, could be a new therapeutic approach to treat both diseases.”

Image credit: iStock.com/FabrikaCr