Mechanisms of airway hyperresponsiveness in asthma.
Airway hyperresponsiveness (AHR) is a fundamental abnormality in asthma. There are many potential factors contributing to the excessive airway response demonstrable on airway challenge. These range from abnormalities of airway smooth muscle, airway remodelling and airway inflammation to abnormalities in the neural control of airway calibre. None of these by themselves fully explains the abnormalities seen on the dose response curves of the asthmatic. In this review, the main mechanisms are described, together with recent evidence providing a pathway by which a number of these mechanisms may interact to cause AHR through abnormality in ventilation distribution and airway closure. There is now evidence for a close relationship between ventilation heterogeneity and AHR which could be exploited clinically.
Berend
Norbert
N
Woolcock Institute of Medical Research, University of Sydney, CRC for Asthma and Airways, Sydney, NSW, Australia. nberend@woolcock.org.au
Salome
Cheryl M
CM
King
Greg G
GG
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D016535:Bronchial Hyperreactivity / Q000503:physiopathology*; D006801:Humans; D012123:Pulmonary Ventilation / Q000502:physiology
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents