The Unified Airway Hypothesis: Evidence From Specific Intervention With Anti-IL-5 Biologic Therapy

Authors

• Claus Bachert
• Amber U Luong
• Philippe Gevaert
• Joaquim Mullol
• Steven G Smith
• Jared Silver
• Ana R Sousa
• Peter H Howarth
• Victoria S Benson
• Bhabita Mayer
• Robert H Chan
• William W Busse

Language

English

Publication Date

9-1-2023

Journal

The Journal of Allergy and Clinical Immunology: In Practice

DOI

10.1016/j.jaip.2023.05.011

PMID

37207831

Abstract

The unified airway hypothesis proposes that upper and lower airway diseases reflect a single pathological process manifesting in different locations within the airway. Functional, epidemiological, and pathological evidence has supported this well-established hypothesis for some time. However, literature on the pathobiologic roles/therapeutic targeting of eosinophils and IL-5 in upper and lower airway diseases (including asthma, chronic rhinosinusitis with nasal polyps [CRSwNP], and nonsteroidal anti-inflammatory drug-exacerbated respiratory disease) has recently emerged. This narrative review revisits the unified airway hypothesis by searching the scientific literature for recent learnings and clinical trial/real-world data that provide a novel perspective on its relevance for clinicians. According to the available literature, eosinophils and IL-5 have important pathophysiological roles in both the upper and lower airways, although the impact of eosinophils and IL-5 may vary in asthma and CRSwNP. Some differential effects of anti-IL-5 and anti-IL-5-receptor therapies in CRSwNP have been observed, requiring further investigation. However, pharmaceutical targeting of eosinophils and IL-5 in patients with upper, lower, and comorbid upper and lower airway inflammation has led to clinical benefit, supporting the hypothesis that these are linked conditions manifesting in different locations. Consideration of this approach may improve patient care and aid clinical decision making.

Keywords

Humans, Rhinitis, Inflammation, Asthma, Sinusitis, Nasal Polyps, Biological Therapy, Chronic Disease, Asthma, Chronic rhinosinusitis with nasal polyps, Eosinophils, IL-5, Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, Unified airway

Published Open-Access

yes

Recommended Citation

Bachert, Claus; Luong, Amber U; Gevaert, Philippe; et al., "The Unified Airway Hypothesis: Evidence From Specific Intervention With Anti-IL-5 Biologic Therapy" (2023). Faculty, Staff and Student Publications. 4056.
https://digitalcommons.library.tmc.edu/uthmed_docs/4056