Airway remodelling in asthma: from benchside to clinical practice

Céline Bergeron, Meri K Tulic, Qutayba Hamid, Céline Bergeron, Meri K Tulic, Qutayba Hamid

Abstract

Airway remodelling refers to the structural changes that occur in both large and small airways relevant to miscellaneous diseases including asthma. In asthma, airway structural changes include subepithelial fibrosis, increased smooth muscle mass, gland enlargement, neovascularization and epithelial alterations. Although controversial, airway remodelling is commonly attributed to an underlying chronic inflammatory process. These remodelling changes contribute to thickening of airway walls and, consequently, lead to airway narrowing, bronchial hyper-responsiveness, airway edema and mucous hypersecretion. Airway remodelling is associated with poor clinical outcomes among asthmatic patients. Early diagnosis and prevention of airway remodelling has the potential to decrease disease severity, improve control and prevent disease expression. The relationship between structural changes and clinical and functional abnormalities clearly deserves further investigation. The present review briefly describes the characteristic features of airway remodelling observed in asthma, its clinical consequences and relevance for physicians, and its modulation by therapeutic approaches used in the treatment of asthmatic patients.

Figures

Figure 1)
Figure 1)
A Hematoxylin and eosin-stained endobronchial biopsy sample from an asthmatic subject showing goblet cell hyperplasia (original magnification ×40). B Hematoxylin and eosin-stained endobronchial biopsy sample from an asthmatic subject showing extensive total subepithelial fibrosis and increased smooth muscle mass (original magnification ×200). C Lung biopsy sample of a small airway from an asthmatic subject showing increased smooth muscle mass and submucosal fibrosis (original magnification ×200)
Figure 2)
Figure 2)
Main airway remodelling features observed in endobronchial biopsies from a severe asthmatic subject. Clinical consequences of each remodelling feature are reported. AHR Airway hyper-responsiveness; BC Bronchoconstriction
Figure 3)
Figure 3)
Transforming growth factor (TGF)-beta messenger RNA (mRNA) expression and subepithelial fibrosis increase with asthma severity. TGF-beta expression is correlated with subepithelial fibrosis. Subepithelial fibrosis was measured by collagen I and III expression levels. Airway biopsies were used to detect TGF-beta and collagen expression. BM Basement membrane. Modified from Minshall et al (132)

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