Tumor necrosis factor (
TNF)-alpha is a proinflammatory
cytokine. Blocking
TNF-alpha has been demonstrated to be effective in various diseases, including both rheumatoid and
psoriatic arthritis. There is evidence to show that levels of
TNF-alpha are elevated in patients with severe
asthma.
TNF-alpha is involved in the initiation and perpetuation of the inflammatory process, epithelial damage and remodeling, and
mucin hypersecretion. Furthermore,
TNF-alpha polymorphism has also been reported in the asthmatic population. Based on the necessity for alternative treatments for asthmatics with severe disease and those who are particularly resistant to conventional
asthma therapy, it has been shown that molecules targeted at blocking the effects of
TNF-alpha probably constitute a considerable advance in the management of these difficult patients. This review focuses on the evidence of
TNF-alpha axis upregulation in severe
corticosteroid-refractory
asthma, as well as the role of
TNF-alpha inhibition and the adverse effects of treatment.