Airway remodelling in children: when does it start?
OBJECTIVE
The review characterizes airway remodelling in childhood asthma and describes how early in life it is possible to detect, and possibly cure, the cellular and biochemical changes that characterize this event. This topic is timely and relevant since a variety of clinical and epidemiologic studies strongly suggest that in asthma, remodelling may start very early in life and that current prevention and treatment measures, including early avoidance measures and pharmaceutical interventions, are relatively ineffective in preventing the development of irreversible airway changes or in reverting them, once established.


RESULTS
Recent findings show that structural changes characterizing remodelling, such as subepithelial basement membrane thickening, epithelial cell disruption, protease/antiprotease imbalance and neoangiogenesis, are detectable in children with asthma and even in children with respiratory symptoms or with atopy, before a clear clinical diagnosis of bronchial asthma is made.


CONCLUSIONS
Identification of the early structural changes that may precede the development of asthma and of factors leading to permanent loss of lung function appear central to future asthma management.
Baena-Cagnani
Carlos
C
Department of Paediatrics, Infantile Hospital, Santa Rosa, Faculty of Medicine, Catholic University of Cordoba, Argentina.
Rossi
Giovanni A
GA
Canonica
Giorgio Walter
GW
D000293:Adolescent; D001249:Asthma / Q000201:enzymology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010447:Peptide Hydrolases / Q000378:metabolism; D012137:Respiratory System / Q000201:enzymology / Q000473:pathology*
D010447:Peptide Hydrolases