Airway obstructive diseases, including bronchial asthma and COPD (chronic obstructive pulmonary disease), are one of the main causes of morbidity and mortality in both industrialized and developing countries, with major social and economic implications. The global data relative to all continents, published by the World Health Organization, indicate that there are currently 150 million asthmatic patients, while the prevalence of COPD relative to both sexes and all age groups, published by the GOLD guidelines, is between 7.33 and 9.34 cases per 1.000 inhabitants. These Airway Obstructive Disease: from Genetics to Perspectives in Treatment figures, however, according to many important studies, may not reflect the real epidemiological dimensions of the problem. The overall health cost for asthma and COPD is much higher than the total of the economic resources employed for all the patients affected by two very widespread infections diseases in the world, like AIDS and tuberculosis. In the next few decades, epidemiological projections forecast a further increase in the incidence and prevalence of asthma and COPD. Asthma and COPD share an inflammatory pathogenic substratum, deriving from complex interactions between predisposing genetic factors and environmental factors. In this connection, the use of modern research methods like molecular genetics, "cDNA microarray" technology and proteomics is helping scientists to pinpoint the identity, structure and profile of expression of the genes responsible for individual susceptibility to asthma and COPD. In the case of asthma, in particular, the many genetic studies carried out in the last few years have made it possible to identify a large number of candidate genes, probably involved in the many pathogenic aspects of the disease. As regards COPD, however, the predisposing factors of a genetic nature are, with the exception of alfa-1 antitripsin deficit, less well-known. Our acquisitions in the field of genetics are essential for an understanding of the relationship between the patient and the environment and the factors that enable the pathological phenotype to express. Studies of cellular and molecular biology, with cyto- and histopathological studies made on the fluid of broncho-alveolar lavages, on induced expectorate and on bronchial biopsies are providing a substantial contribution to characterization of the inflammatory response and specifying the actual mechanisms involved in asthma and COPD. Also, enormous progress has been made in the understanding of the exact nature of the phenomena of structural remodeling of the walls of the respiratory tract, which occur in these two diseases. An understanding of the specific genetic, cellular and molecular characteristics is also indispensable to explain the phenotype diversity, as regards clinical expression, natural history and response to therapy observed in patients affected by asthma or COPD. Furthermore, the increased understanding of the molecular bases of these pathologies has important implications in the therapeutic field, especially as regards the development of new lines of research relative to pharmacological and immuno-therapeutic strategies, in the sphere of which a concrete example is already available in the form of monoclonal anti-IgE antibodies as well as specific antagonists of chemochine receptors. In addition, increased knowledge in the field of genetic pharmacology will make it possible to develop a more individualized approach based on the specific characteristics of each patient.
Serafino A. Marsico and Gennaro D'Amato Co-Presidents of the Meeting