Pathogenetic Mechanisms of Chronic Obstructive Pulmonary Diseases

Objectives: To evaluate the patterns of pathophysiology and genetic predisposition of COPD and asthma Tasks: To evaluate patients that respond to corticosteroids and those who do not Compare the inflammatory markers: * of COPD and asthma patients before and after treatment with inhaled glucocorticoids * of COPD and asthma patients that respond to inhaled glucocorticoids and those who do not * of nonsmokers and smokers asthma patients To identify a small set of markers that can be used to predict corticosteroid-treatment response in patients with COPD. To evaluate epigenetic factors To compare gene mutation and polymorphism between study groups To evaluate the relationship between genetic predisposition and pathophysiology, clinical symptoms To evaluate the relationship between patterns of pathophysiology and clinical symptoms, lung function, quality of life in patients with chronic obstructive pulmonary diseases. Visit 1 Written informed consent will be obtained * A full medical, surgical, smoking, labour history. A physical examination will be performed * Resting SaO2 will be measured, exhaled nitric oxide (FENO) * Chest X-ray * Patient will fulfil questionnaires * Spirometry and bronchodilatation test * Sputum induction and samples will be performed Visit 2 • Blood samples for blood clotting test and immunological markers will be taken• Cough inhalation challenge Visit 3 * Patient will be hospitalized to the Department of Pulmonology and Immunology * Blood samples for genetic analysis will be taken * Urinary samples will be taken• Methacholine challenge test Polysomnography * Bronchoscopy (biopsy and BAL) * Study drug administration Visit 4 and 5 * Adverse events, COPD or asthma exacerbation, concomitant medications will be recorded, exhaled nitric oxide (FENO) * Spirometry * Patient will fulfil questionnaires * Cough inhalation challenge Visit 6 * Patient will fulfil questionnaires * Spirometry and bronchodilatation test. * Sputum induction and samples will be performed Visit 7 • Blood samples for blood clotting test, immunological and genetic analysis will be taken• Cough inhalation challenge Visit 8 * Patient will be hospitalized to the Department of Pulmonology and Immunology * Urinary samples will be taken• Methacholine challenge test Polysomnography * Bronchoscopy (biopsy and BAL) * Further treatment administration