Tillie-Leblond I, Louis R, Magnan A, Humbert M, de Blic J, Chanez P
Service de Pneumologie et d'Immunolo-Allergologie, CHRU de Lille, Hôpital Albert Calmette, Lille, France.
Rev Mal Respir. 2009 Oct;26(8):851-8. doi: 10.1016/s0761-8425(09)73680-0.
Inflammation and remodelling are constant features of asthma. They are present throughout the whole bronchial tree, even in the small airways (less than 2 mm). The inflammatory cell infiltrate and structural changes are, in most cases, identical. However, in severe asthma, nocturnal asthma and fatal asthma, the cellular infiltrate in the distal airways is more intense and the number of activated cells is increased. In fatal asthma there are major alterations in the distal airways involving the smooth muscle and the bronchial epithelium, and mucus hypersecretion leading to distal airway plugging. Thus the histopathological changes in the distal airways contribute to the most severe stages of asthma and should be targeted by treatment. Currently the non-invasive tools that reflect inflammation are unable to assess these changes in the distal airways.
炎症和重塑是哮喘的持续特征。它们存在于整个支气管树中，甚至在小气道（直径小于2毫米）中也存在。在大多数情况下，炎性细胞浸润和结构变化是相同的。然而，在重度哮喘、夜间哮喘和致死性哮喘中，远端气道的细胞浸润更为强烈，活化细胞数量增加。在致死性哮喘中，远端气道存在涉及平滑肌和支气管上皮的重大改变，以及黏液分泌过多导致远端气道堵塞。因此，远端气道的组织病理学变化促成了哮喘的最严重阶段，治疗应针对这些变化。目前，反映炎症的非侵入性工具无法评估远端气道的这些变化。
