Structural consequences of airway inflammation in asthma,☆☆

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Abstract

Asthma represents a chronic inflammatory process of the airways followed by healing, the end-result of which is an altered structure referred to as a remodeling of the airways. Repair usually involves 2 distinct processes: regeneration (which is the replacement of injured tissue by parenchymal cells of the same type) and replacement by connective tissue and its eventual maturation into scar tissue. In many instances both processes contribute to the healing response and inflammation. In asthma the processes of cell dedifferentiation, migration, differentiation, and maturation and connective tissue deposition can be followed either by complete or altered restitution of airway structure and function, the latter often seen as fibrosis and increase in smooth muscle and mucus gland mass. These features result in an increased resistance to airflow, particularly when there is bronchial contraction and bronchial hyperresponsiveness. The effect on airflow is compounded by the presence of increased mucous secretion and inflammatory exudate, which not only blocks the airway passages but also causes an increased surface tension that favors airway closure. (J Allergy Clin Immunol 2000;105:S514-17.)

Section snippets

Airway wall thickness and bronchial hyperreactivity

In chronic obstructive disorders, bronchial hyperreactivity appears to be correlated with airway caliber; histamine or methacholine challenge appears to be associated with the prechallenge FEV1 level.14, 15 However, both studies differed because there was a linear relationship between baseline FEV1 level and response to methacholine in patients with asthma and patients with chronic bronchitis, although the response to methacholine was greater in the patient with asthma than in the patients with

Abnormal pulmonary function in patients with asthma

For decades, asthma has been considered a completely reversible obstructive disease; in most patients, complete reversibility of long-standing abnormal spirometric measurements, such as FEV1 level, may be observed after bronchodilators and/or a course of corticosteroids. On the other hand, many patients with asthma (both children and adults) have evidence of residual airway obstruction,33, 34, 35 which may even be noticed in some asymptomatic patients.36 However, this irreversible component of

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    Reprint requests: Pr Jean Bousquet , MD, PhD, Clinique des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Centre Hospitalier Universitaire, 34295 Montpellier Cedex 5, France.

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