The hallmark pathological features of asthma include airway eosinophilic inflammation and structural changes (remodelling). They are associated with an irreversible loss in lung function that tracks from childhood to adulthood.
In parallel with changes in function, pathological abnormalities occur early, during the pre-school years. They are established by school age and subsequently remain, even though symptoms may remit for periods during adulthood.
Targeting inflammation alone has not allowed disease modification. Therefore, unless airway remodelling is addressed, it is unlikely that we will progress towards a cure for asthma.
This review highlight the gaps in our current knowledge about:
- mechanisms underlying airway remodelling
- relationships between remodelling, inflammation and function, remodelling and clinical phenotypes
- realistic pre-clinical models to uncover effective, disease-modifying therapies
Novel concepts in airway inflammation and remodelling in asthma. Saglani S, Lloyd CM. Eur Respir J. 2015 Dec;46(6):1796-804. doi: 10.1183/13993003.01196-2014. Epub 2015 Nov 5.
Disclaimer: I have been the Editor of the World Allergy Organization (WAO) Small Airways Working Group "What's New?" monthly summary since 2011. The summary features the top 3 asthma/small airways articles each month. The article above is part of the project. The archive is here: http://www.worldallergy.org/small_airways_group/reviews/archive.php
Image source: Spirometry, from Wikipedia, the free encyclopedia, GNU Free Documentation License.