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AIMS Allergy and Immunology

2026, Volume 10, Issue 2: 52-70. doi: 10.3934/Allergy.2026006
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The role of the lung-brain axis in asthma exacerbations

  • Faculty of Medicine, Medical University of Lodz, Lodz, Poland
  • Published: 22 May 2026

  • Asthma is a heterogeneous pulmonary disease characterized by airway hyperresponsiveness and chronic inflammation, and affects from 1% to 29% of the population in different countries. The pathogenesis of this disease is multifaceted; in addition to the crucial role of the immune system, its development involves environmental and genetic factors. Asthma is manifested by wheezing, shortness of breath, and chest tightness, and characteristic of this disease is that symptoms vary over time and in intensity. Studies have suggested that the special communication, lung-brain axis, has a potential role in the course of pulmonary diseases, including asthma. This term relates to the bidirectional relationship between the brain and the lung, which has communication comprising the central and peripheral nervous systems, the endocrine system, the immunological systems, and microbiota. These elements cooperate to create a complex system of bilateral interactions between the lung and the central nervous system. Our aim of this article was to summarize and organize knowledge about the role of the lung-brain axis during asthma exacerbation, a state which is defined as the worsening of a patient's symptoms and lung function parameters over a defined period.

    Citation: Kamil Marszałek, Klaudia Dobrowolska, Natalia Krupińska. The role of the lung-brain axis in asthma exacerbations[J]. AIMS Allergy and Immunology, 2026, 10(2): 52-70. doi: 10.3934/Allergy.2026006

    Related Papers:

  • Asthma is a heterogeneous pulmonary disease characterized by airway hyperresponsiveness and chronic inflammation, and affects from 1% to 29% of the population in different countries. The pathogenesis of this disease is multifaceted; in addition to the crucial role of the immune system, its development involves environmental and genetic factors. Asthma is manifested by wheezing, shortness of breath, and chest tightness, and characteristic of this disease is that symptoms vary over time and in intensity. Studies have suggested that the special communication, lung-brain axis, has a potential role in the course of pulmonary diseases, including asthma. This term relates to the bidirectional relationship between the brain and the lung, which has communication comprising the central and peripheral nervous systems, the endocrine system, the immunological systems, and microbiota. These elements cooperate to create a complex system of bilateral interactions between the lung and the central nervous system. Our aim of this article was to summarize and organize knowledge about the role of the lung-brain axis during asthma exacerbation, a state which is defined as the worsening of a patient's symptoms and lung function parameters over a defined period.


    Abbreviations

    ACC

    Anterior cingulate cortex

         ACT

    Asthma control test

         AEs

    Asthma exacerbations

         ATP

    Adenosine triphosphate

         BALF

    Bronchoalveolar lavage fluid

         BBB

    Blood–brain barrier

         BDNF

    Brain-derived neurotrophic factor

         CCL11

    C-C motif chemokine ligand 11, eotaxin-1

         CFU

    Colony-forming unit

         CGRP

    Calcitonin gene-related peptide

         CMV

    Cytomegalovirus

         CNS

    Central nervous system

         CRSwNP

    Chronic rhinosinusitis with nasal polyps

         CS

    Cytokine storm

         CXCL-1, -2, -8, -9, -10

    Chemokine (C-X-C motif) ligand -1, -2, -8, -9, -10

         E

    Epinephrine

         EAACI

    European Academy of Allergy and Clinical Immunology

         ECM1

    Extracellular matrix protein 1

         ERS

    European Respiratory Society

         FEF25–75%

    Forced Expiratory Flow 25–75%

         FEV1

    Forced Expiratory Volume in 1 second

         FRC

    Functional Residual Capacity

         GERD

    Gastroesophageal reflux disease

         GINA

    Global Initiative for Asthma

         HBI

    Hypoxic brain injury

         HPA axis

    Hypothalamic–pituitary–adrenal axis

         ICS

    Inhaled corticosteroids

         IFN

    Interferon

         IgE

    Immunoglobulin E

         IL-1α

    Interleukin-1α

         IL-1β

    Interleukin-1β

         IL-4

    Interleukin-4

         IL-5

    Interleukin-5

         IL-6

    Interleukin-6

         IL-8

    Interleukin-8

         IL-13

    Interleukin-13

         IL-17

    Interleukin-17

         IL-22

    Interleukin-22

         IL1R1

    Interleukin-1 receptor type 1

         IMV

    Invasive mechanical ventilation

         LBA

    Lung–brain axis

         LPS

    Lipopolysaccharide

         MDD

    Major depressive disorder

         MERS-CoV-1

    Middle East respiratory syndrome coronavirus-1

         MIP-1β

    Macrophage inflammatory protein-1 beta

         MMP-9

    Matrix metalloproteinase 9

         NE

    Norepinephrine

         NGF

    Nerve growth factor

         NIV

    Non-invasive ventilation

         NK cells

    Natural killer cells

         NMDA

    N-methyl-D-aspartate

         NO

    Nitric oxide

         NOS

    Nitric oxide synthetase

         NOTCH-1

    Notch receptor 1

         NPY

    Neuropeptide Y

         NT3

    Neurotrophin 3

         NT4

    Neurotrophin 4

         NTs

    Neurotrophins

         OMVs

    Outer-membrane vesicles

         PCFs

    Bronchopulmonary C-fibres (PCFs)

         PD-L1

    Programmed death-ligand 1

         PDLIM4

    PDZ and LIM domain protein 4

         PEF

    Peak Expiratory Flow

         PGD2

    Prostaglandin D2

         PNECs

    Pulmonary neuroendocrine cells

         ROS

    Reactive oxygen species

         RS

    Respiratory system

         SAE

    Sepsis-associated encephalopathy

         SARS-CoV-1

    Severe Acute Respiratory Syndrome coronavirus 1

         SARS-CoV-2

    Severe Acute Respiratory Syndrome coronavirus 2

         SBP-Ag

    Staphylococcal bacterial protein antigen

         SP

    Substance P

         SpO2

    Peripheral Capillary Oxygen Saturation

         Treg cells

    Regulatory T cells

         TNF-α

    Tumour necrosis factor alpha

         TRPV1

    Transient receptor potential vanilloid 1

         V/Q

    ventilation-perfusion ratio

         VEGF-A

    Vascular endothelial growth factor A

         VIP

    Vasoactive intestinal peptide

         VN

    Vagus nerve

         VNS

    Vagus nerve stimulation

         WHO

    World Health Organization
    加载中


    Conflict of interest


    All authors declare no conflicts of interest in this paper.

    Author contributions


    Conceptualization: KM, Writing an original draft: KM, NK, Review and Editing: KD.

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