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Pulmonary remodeling in asthma.

P Lieberman1, S W Yates, K Welk

  • 1Division of Allergy and Immunology, Dept of Medicine, University of Tennessee, Memphis, Cordova 38018, USA. asthmamemphis@msn.com

Journal of Investigational Allergology & Clinical Immunology
|March 23, 2002
PubMed
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Some asthmatics develop permanent obstructive lung disease due to airway remodeling. Factors like disease severity and duration increase risk, but inhaled corticosteroids may help slow lung function decline.

Area of Science:

  • Pulmonology
  • Pathology

Background:

  • Traditionally, asthma was considered fully reversible.
  • Longitudinal studies and biopsy data reveal irreversible obstructive lung disease in some asthmatics.
  • This includes accelerated lung function decline in adults and failure to reach normal lung volumes in children.

Purpose of the Study:

  • To investigate the mechanisms behind permanent obstructive lung disease in asthma.
  • To identify risk factors for irreversible airway changes.
  • To explore the potential of treatments like inhaled corticosteroids in mitigating airway remodeling.

Main Methods:

  • Analysis of longitudinal FEV1 (Forced Expiratory Volume in 1 second) data.
  • Examination of lung biopsy data for histologic changes.
  • Review of studies on risk factors and treatment effects.

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Main Results:

  • Histologic evidence suggests collagen and glycoprotein deposition and elastic tissue destruction contribute to permanent obstruction.
  • Increased disease severity, duration, and bronchial hyperresponsiveness are linked to higher risk.
  • Inhaled corticosteroids may reduce lamina reticularis thickness and slow FEV1 decline.
  • Removal of occupational asthma triggers, like toluene diisocyanate, shows beneficial effects.

Conclusions:

  • Asthma can lead to permanent obstructive lung disease, contrary to previous assumptions.
  • Airway remodeling, characterized by specific histologic changes, underlies this irreversible condition.
  • Early and effective management, potentially including inhaled corticosteroids and trigger avoidance, may be crucial in preventing or slowing disease progression.