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Novel views on endotyping asthma, its remission, and COPD

PhD ceremony:dr. O.A. (Orestes Alexander) Carpaij
When:November 09, 2020
Supervisor:prof. dr. H.A.M. (Huib) Kerstjens
Co-supervisors:M. (Maarten) van den Berge, dr. ir. M.C. (Martijn) Nawijn
Where:Academy building RUG

The chapters presented in this thesis provide an overview of what is known about asthma remission, further characterize of complete asthma remission, elaborate on the asthma-obesity complexity, apply cutting edge techniques to endotype asthma and COPD as well as novel devices to analyze airway remodeling and small airways dysfunction.

Various conclusions have been made: I. In order to elucidate the pathophysiological state of asthma remission, future studies should focus on complete asthma remission, since this phenomenon is likely to yield superior prognostic and scientific impact. This is of interest, since elucidation of the pathophysiology of asthma remission could potentially lead to new treatment options for asthma. II. To clearly predict asthma remission later in life, we need to integrate biomarkers with clinical features at asthma-onset. III. Measuring particles of exhaled air correlates with large, and indirectly, small airways parameters, in asthmatics, clinical-, complete asthma remission subjects, and healthy controls. IV. Transcriptomic bronchial cell typing (e.g. single-cell RNA-sequencing) characterizes the landscape of lung-resident structural and inflammatory cells and their interactions, enabling us to identify differences in proportions and transcriptional output of cells between asthmatics and healthy.V. Optical coherence tomography enables us to quantify extracellular matrix components in the airway wall, such as collagen. This now allows for future studies ‘in vivo’ to explore the clinical characteristics and the underlying pathobiology related to airway remodeling in asthma and asthma remission.VI. The asthma-obesity syndrome is a common combination of diseases with its own distinct pathophysiological processes.VII. There will presumably be no room for serum periostin in COPD clinical decision-making. VIII. Transcriptomic profiling can be implemented as a biomarker for COPD patient prognosis.