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Refractory or difficult-to-control asthma is associated with some clinical and pathological features normally associated with chronic obstructive pulmonary disease (COPD), raising the possibility that there are similarities in their pathogenesis. It is suggested that the coexistence of two or more inflammatory stimuli to the airway (multiple hits) is a key factor leading to the development of more severe airway disease. Airway inflammation in response to chronic inflammatory conditions elsewhere may be a particularly important additional inflammatory stimulus. The "multiple hit" hypothesis for the origins of severe airway disease has important implications for treatment and prevention, since identification and removal of additional inflammatory stimuli may delay progression of the underlying airway disease.

Original publication

DOI

10.1183/09031936.06.00128105

Type

Journal article

Journal

Eur Respir J

Publication Date

05/2006

Volume

27

Pages

884 - 888

Keywords

Asthma, Humans, Inflammation, Pulmonary Disease, Chronic Obstructive, Severity of Illness Index