Authors: Andrew J Ghio
Publish Date: 2016/09/05
Volume: 29, Issue: 5, Pages: 751-779
Abstract
Over several decades asthma has evolved from being recognized as a single disease to include a diverse group of phenotypes with dissimilar natural histories pathophysiologies responses to treatment and distinctive molecular pathways With the application of Occam’s razor to asthma it is proposed that there is one cause underlying the numerous phenotypes of this disease and that the responsible molecular pathway is a deficiency of iron in the lung tissues This deficiency can be either absolute eg asthma in the neonate and during both pregnancy and menstruation or functional eg asthma associated with infections smoking and obesity Comparable associations between asthma comorbidity eg eczema urticaria restless leg syndrome and pulmonary hypertension with iron deficiency support such a shared mechanistic pathway Therapies directed at asthma demonstrate a capacity to impact iron homeostasis further strengthening the relationship Finally pathophysiologic events producing asthma including inflammation increases in Th2 cells and muscle contraction can correlate with iron availability Recognition of a potential association between asthma and an absolute and/or functional iron deficiency suggests specific therapeutic interventions including inhaled iron
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