New article in ERJ on Novel concepts in airway inflammation and remodelling in asthma!
The hallmark pathological features of asthma include airway eosinophilic
inflammation and structural changes (remodelling) which 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, are established
by school age and subsequently remain (even though symptoms may remit
for periods during adulthood). Given the equal importance of
inflammation and remodelling in asthma pathogenesis, there is a
significant disparity in studies undertaken to investigate the
contribution of each. The majority focus on the role of inflammation,
and although novel therapeutics such as those targeted against T-helper
cell type 2 (Th2) mediators have arisen, it is apparent that targeting
inflammation alone has not allowed disease modification.
Therefore,
unless airway remodelling is addressed for future therapeutic
strategies, it is unlikely that we will progress towards a cure for
asthma. Having acknowledged these limitations, the focus of this review
is to highlight the gaps in our current knowledge about the mechanisms
underlying airway remodelling, the relationships between remodelling,
inflammation and function, remodelling and clinical phenotypes, and the
importance of utilising innovative and realistic pre-clinical models to
uncover effective, disease-modifying therapeutic strategies.
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