First, chronic airway inflammation drives endothelial dysfunction through multiple mechanisms: various inflammatory mediators (such as TNF-α, IL-1β, IL-6) can damage endothelial cells; the activation of Toll-like receptors (TLRs) and the NLRP3 inflammasome leads to endothelial dysfunction; and the NF-κB signaling pathway activates endothelial cells, upregulating adhesion molecules (such as VCAM-1, ICAM-1) (9). Here, TNF is linked to endothelial dysfunction.