p38 Mitogen-Activated Protein Kinase (MAPK) and Steroid Insensitivity in Asthma

DESIGN Comparative study to analyse differences in the characteristics of lung macrophages and blood monocytes between non-severe and severe asthmatics. AIMS 1. To determine whether there are differences in terms of cell expression and activation between lung macrophages and blood monocytes from non-severe and severe asthma 2. To determine the mechanisms of the lung macrophage and blood monocyte relative resistance to the effect of corticosteroids in severe asthma, and particularly focus on the role of p38 MAPK 3. To determine the differences in airway smooth muscle cells between non-severe and severe asthma OUTCOME MEASURES 1. Clinically the differences in inflammatory and remodelling markers between non-severe and severe asthma 2. Differences in histone phosphorylation, NF-kB activity and glucocorticoid receptor activation and actions in macrophages and monocytes between non- severe and severe asthma 3. Differences in behaviour of airway smooth muscle cells cultured from biopsies obtained from non-severe and severe asthma Severe and non-severe asthmatic subjects will be classified following ATS criteria. They undergo spirometry with reversibility testing, PC20, skin prick tests, exhaled nitric oxide measurements and induced sputum. They will have blood taken for PBMCs and undergo fiberoptic bronchoscopy for obtention of alveolar macrophages and bronchial biopsies