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Asthma Therapy and Its Effect on Airway Remodelling

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Abstract

Asthma remains a major health problem with significant morbidity, mortality and economic costs. In asthma, airway remodelling, which refers to all the microscopic structural changes seen in the airway tissue, has been recognised for many decades and remains one of the defining characteristics of the disease; however, it is still poorly understood. The detrimental pathophysiological consequences of some features of remodelling, like increased airway smooth muscle mass and subepithelial fibrosis, are well documented. However, whether targeting these by therapy would be beneficial is unknown. Although the prevailing thinking is that remodelling is an abnormal response to persistent airway inflammation, recent evidence, especially from studies of remodelling in asthmatic children, suggests that the two processes occur in parallel. The effects of asthma therapy on airway remodelling have not been studied extensively due to the challenges of obtaining airway tissue in the context of clinical trials. Corticosteroids remain the cornerstone of asthma therapy, and their effects on remodelling have been better studied than other drugs. Bronchial thermoplasty is the only asthma therapy to primarily target remodelling, although how it results in the apparent clinical benefits seen is not exactly clear. In this article we discuss the mechanisms of airway remodelling in asthma and review the effects of conventional and novel asthma therapies on the process.

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Acknowledgments

CEB is funded by AirPROM (FP7 270194). This article is supported by the National Institute for Health Research (NIHR) Leicester Respiratory Biomedical Research Unit. The views expressed are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health. CEB has received grant funding and consultancy from Novartis, GSK, Genentech/Roche, Chiesi and Medimmune/AstraZeneca. RB declares no conflict of interest.

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  1. Department of Infection, Immunity and Inflammation, Institute for Lung Health, Glenfield Hospital, University of Leicester, Leicester, LE3 9QP, UK

    Rachid Berair & Christopher E. Brightling

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Berair, R., Brightling, C.E. Asthma Therapy and Its Effect on Airway Remodelling. Drugs 74, 1345–1369 (2014). https://doi.org/10.1007/s40265-014-0250-4

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