Airway wall remodelling: the influence of corticosteroids.
OBJECTIVE
We have attempted to bring together recent findings, mainly from airway endobronchial biopsies, on the structural changes that constitute 'remodelling' in airway disease, with a particular focus on asthma. We have tried to put this into the context of classic studies on the asthma pathological phenotype. Having described these basic changes, we have then given an update on recent studies investigating the effects of corticosteroid medication on the different manifestations of remodelled airways.


RESULTS
The effects of corticosteroid on airway remodelling seem to vary a great deal; some aspects are steroid responsive while others are not, or less so. It is likely that different manifestations of remodelling require different doses and timescales for treatment to be effective.


CONCLUSIONS
Further longitudinal interventional studies are required, with multiple airway sampling times, to fully elucidate the full potential for corticosteroids to benefit remodelling of the airways in chronic inflammatory diseases. There needs to be more attention to pathophysiological and clinical correlations in such studies. It is likely that even when used optimally corticosteroids will have limited efficacy overall in this aspect of asthma pathogenesis. The search is on for newer and better treatments.
Ward
Chris
C
Immunobiology and Transplantation Group, Sir William Leech Centre, The Freeman Hospital and University of Newcastle upon Tyne, UK. chris.ward@ncl.ac.uk
Walters
Haydn
H
D000305:Adrenal Cortex Hormones / Q000494:pharmacology* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000473:pathology*; D001980:Bronchi / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D009130:Muscle, Smooth / Q000378:metabolism / Q000473:pathology; D020545:Respiratory Mucosa / Q000378:metabolism / Q000473:pathology*
D000305:Adrenal Cortex Hormones