Airway remodeling from bench to bedside: Current perspectives

The airway inflammation and structural changes related to asthma exist as a continuum of clinical phenotypes and molecular pathophysiology. The severity of the disease is heterogeneous and begins during childhood amidst critical stages of growth and development. Treatment is similarly diverse, at times even frustrating, because certain patients experience a precipitous decline in pulmonary function, which requires maximal therapy and manifests remarkable alterations of physiology. Although steroid therapy is helpful in symptomatic control, it does not clearly engender the remediation of structural alterations or all aspects of the inflammatory milieu. Future investigation will, in part, be focused on three crucial goals: (1) distinguishing pathophysiological events that determine asthmatic phenotypes, (2) targeting specific phenotypes with novel therapies, (3) establishing a precise chronology of disease evolution, with particular attention to the self-sustaining cycles of inflammation and structural change. Remodeling can be an entirely normal sequence of events that is under dysregulation in asthmatic patients, secondary to a multitude of factors from altered biomechanics to tissue damage and inflammation.