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Airway Remodeling in Asthma and Therapeutic Implications

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Book cover Allergy Frontiers: Clinical Manifestations

Part of the book series: Allergy Frontiers ((ALLERGY,volume 3))

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Abstract

Airway inflammation is a defense response to potentially harmful antigens. In allergic asthma the offending antigens are allergens, the inflammatory response being, in fact, inappropriate in terms of host survival. In non-allergic asthma, the offending antigens and the vicious immunological cycle they elicit are still not fully understood. In susceptible individuals, long-term, repeated and marked inflammation may result in disturbed function (variable airway narrowing and hyperresponsiveness), and only then asthma, by definition, is diagnosed. This is more or less a late stage because the inflammation may periodically exist long before the functional changes appear. Chronic inflammation causes tissue injury, which is partly repaired between inflammatory exacerbations. Remodeling is developed during the cycle of injury and repair and gradually affects lung function. Remodeling seems to be the cause of more or less persistent airway hyperresponsiveness and fixed airway obstruction, which label moderate to severe, persistent asthma. Examination of bronchial tissue, even in mild asthma, shows lymphocytic inflammation enriched by eosinophils. In severe asthma, the predominant pattern of inflammation changes, with increase in the number of neutrophils and, in many, an extension of the changes to involve smaller airways (i.e., bronchioli). Structural alterations of bronchi already in mild asthma include epithelial fragility and some thickening of its reticular basement membrane. With increasing severity of asthma there may be increases in airway smooth muscle mass, neo-vascularisation, accumulation of interstitial collagen, and mucus-secreting glands. There is very little data to indicate that marked airway remodeling, already accompanied by clearly abnormal lung function could be reversed by any treatment. Early detection of the disease process and effective intervention with anti-inflammatory medication, especially with inhaled corticosteroids, remain the best option. Persistent asthma is usually accompanied by rhinitis, and treating both conditions improve the outcomes. Finally, most asthmatics have a relatively mild disease, which does not significantly affect their lung function or performance over the years.

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  1. Professor of Clinical Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, 160, HUS, 00029, Finland

    Tari Haahtela

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  1. Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan

    Ruby Pawankar

  2. Southampton General Hospital, University of Southampton, Tremona Road, Southampton, UK

    Stephen T. Holgate

  3. Childrens's Mercy Hospital and Clinic, UMKC School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Lanny J. Rosenwasser

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Haahtela, T. (2009). Airway Remodeling in Asthma and Therapeutic Implications. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Clinical Manifestations. Allergy Frontiers, vol 3. Springer, Tokyo. https://doi.org/10.1007/978-4-431-88317-3_18

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