Remodeling in small airways of asthma

SummaryAirway inflammatory processes are pivotal as the pathological features of bronchial asthma. Standard therapy with inhaled corticosteroids markedly suppresses such inflammatory changes, resulting in clinical beneficial effects. However, it is now clear that several histological changes including goblet cell hyperplasia, subepithelial collagen deposits, increased capillary networks and smooth muscle hypertrophy can occur as a chronic consequence of this airway disorder even when asthma is treated with inhaled or oral steroids. These pathologic changes, the so-called remodeling, play an important role in increased airway obstruction, increased clinical severity and difficulty in controlling asthma, and eventually in the development of irreversible respiratory failure. Targeting these remodeling changes may become a new specific therapeutic strategy for controlling asthma.