Pathogenetic Mechanisms of Chronic Obstructive Pulmonary Diseases
Pathogenetic Mechanisms of Chronic Obstructive Pulmonary Diseases
Asthma and chronic obstructive pulmonary disease(COPD) are common diseases, which tend to
 even increase in many countries. Both from a clinical and a pathophysiological point of view,
 this is an important issue. However, an understanding of the relationship between the complex
 array of cells and mediators involved in asthma and COPD is not yet fully dissected which
 makes difficult to find a specific and sensitive panel of biomarkers that can reflect
 intensity of these pathological processes and can help to predict the individual outcome.
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
Inclusion Criteria:

 -  Male or female outpatients aged 40-80 years inclusive.

 -  An established clinical history of COPD as defined by the GOLD guidelines.

 -  COPD patients with a baseline (pre-bronchodilator) FEV1 40-80% of predicted normal
 value; post-bronchodilator FEV1/FVC ratio ≤ 70% predicted.

 -  COPD patients with a smoking history (current or ex-smoker) of ≥10 pack years or those
 who have exposure to occupational dust and chemicals

 -  An established clinical history of asthma defined by the GINA recommendations.

 -  Subjects with out hypoxemia (all subjects must have an O2 saturation ≥88% on room
 air).

 Control (healthy) subjects with baseline FEV1 >80% of predicted normal value

 -  A female is eligible to participate this study if she is of non-childbearing
 potential, or childbearing potential has a negative pregnancy test.

 -  Patients who did not use inhaled and oral corticosteroids 6 weeks and/or long acting
 bronchodilators 4 weeks before study.

 Exclusion Criteria:

 -  There is a current respiratory disorder other than COPD and asthma (e.g. lung cancer,
 sarcoidosis, active tuberculosis etc.)

 -  Subjects who have had a COPD and asthma exacerbation or respiratory infection in the 4
 weeks before Visit 1.

 -  Subjects with a chest X-ray indicating diagnosis other than COPD or asthma that might
 interfere with the study.

 -  Subjects who are unable to stop treatment with inhaled, and oral corticosteroids 6
 weeks and/or long acting bronchodilators 4 weeks before study.

 -  Subjects receiving treatment with cromolyn sodium or nedocromil, oral beta2 -
 agonists, long acting anticholinergic, leucotriene modifiers

 -  Subjects who have had lung surgery.

 -  Subjects with bleeding diathesis.

 -  Subjects receiving treatment with long-term oxygen therapy.

 -  Subjects with serious, uncontrolled diseases those are uncontrolled on permitted
 therapy.