Tiotiu Angelica, Steiropoulos Paschalis, Novakova Silviya, Nedeva Denislava, Novakova Plamena, Chong-Neto Herberto, Fogelbach Guillermo Guidos, Kowal Krzysztof
Department of Pulmonology, University Hospital Saint-Luc, Brussels, Belgium; Pole Pneumology, ENT, and Dermatology - LUNS, Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
Department of Pulmonology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
Arch Bronconeumol. 2025 Jan;61(1):31-40. doi: 10.1016/j.arbres.2024.09.007. Epub 2024 Sep 24.
Airway remodeling (AR) with chronic inflammation, are key features in asthma pathogenesis. AR characterized by structural changes in the bronchial wall is associated with a specific asthma phenotype with poor clinical outcomes, impaired lung function and reduced treatment response. Most studies focus on the role of inflammation, while understanding the mechanisms driving AR is crucial for developing disease-modifying therapeutic strategies. This review paper summarizes current knowledge on the mechanisms underlying AR, diagnostic tools, and therapeutic approaches. Mechanisms explored include the role of the resident cells and the inflammatory cascade in AR. Diagnostic methods such as bronchial biopsy, lung function testing, imaging, and possible biomarkers are described. The effectiveness on AR of different treatments of asthma including corticosteroids, leukotriene modifiers, bronchodilators, macrolides, biologics, and bronchial thermoplasty is discussed, as well as other possible therapeutic options. AR poses a significant challenge in asthma management, contributing to disease severity and treatment resistance. Current therapeutic approaches target mostly airway inflammation rather than smooth muscle cell dysfunction and showed limited benefits on AR. Future research should focus more on investigating the mechanisms involved in AR to identify novel therapeutic targets and to develop new effective treatments able to prevent irreversible structural changes and improve long-term asthma outcomes.
气道重塑（AR）伴有慢性炎症，是哮喘发病机制的关键特征。以支气管壁结构改变为特征的AR与一种特定的哮喘表型相关，该表型具有临床预后差、肺功能受损和治疗反应降低的特点。大多数研究集中在炎症的作用上，而了解驱动AR的机制对于制定改善疾病的治疗策略至关重要。这篇综述文章总结了目前关于AR潜在机制、诊断工具和治疗方法的知识。探讨的机制包括驻留细胞和炎症级联反应在AR中的作用。描述了支气管活检、肺功能测试、成像等诊断方法以及可能的生物标志物。讨论了包括皮质类固醇、白三烯调节剂、支气管扩张剂、大环内酯类、生物制剂和支气管热成形术在内的不同哮喘治疗方法对AR的有效性，以及其他可能的治疗选择。AR在哮喘管理中构成了重大挑战，导致疾病严重程度增加和治疗抵抗。目前的治疗方法主要针对气道炎症，而非平滑肌细胞功能障碍，对AR的益处有限。未来的研究应更多地关注研究AR所涉及的机制，以确定新的治疗靶点，并开发能够预防不可逆结构改变并改善哮喘长期预后的新的有效治疗方法。
