Evidence of a Role of Tumor Necrosis Factor α in Refractory Asthma

Patients with severe asthma are distinct from patients with milder forms of the disease. Peripheral-blood monocytes from patients with severe asthma were shown to have enhanced expression of markers associated with tumor necrosis factor α (TNF-α). In a pilot, placebo-controlled, crossover study, the TNF-α receptor–binding agent etanercept improved airway responsiveness and asthma-related quality of life. TNF-α may have a role in refractory asthma. In a pilot study, the TNF-α receptor–binding agent etanercept improved airway responsiveness and asthma-related quality of life. TNF-α may have a role in refractory asthma. The rates of death and complications are high among patients with refractory asthma and account for a disproportionate amount of the health resource burden attributed to asthma. 1 Treatment options are limited for these patients. The airway abnormality in refractory asthma differs from that in mild-to-moderate asthma in having a more heterogeneous pattern of inflammatory response, 2 with greater involvement of neutrophils 3 and the distal lung 4 and increased airway remodeling. 5 Tumor necrosis factor α (TNF-α) is a pleiotropic inflammatory cytokine expressed in increased amounts by mast cells 6 and present in increased concentrations in bronchoalveolar fluid from the airways of patients with asthma. . . .