What are the effects of corticosteroids on airway remodeling?
Corticosteroids, either inhaled (ICSs) or systemic (oral corticosteroids), modulate acute and chronic inflammation in asthmatic subjects, particularly in those with milder disease, and have broad pharmacologic actions.14 and 15 Consequently, glucocorticoids are considered the therapeutic mainstay for chronic asthma and its underlying inflammation. Indeed, as a result of the “chronic inflammation leads to remodeling” paradigm, corticosteroids have long played a central role in interventional studies to assess the effect of treatment on airway remodeling in asthmatic subjects. However, the aforementioned recent childhood airway studies have cast doubt on this model. New evidence suggests remodeling might arise from asthma exacerbations and not chronic inflammation,5, 6, 7 and 8 and these events ultimately lead to an exaggerated decrease in lung function.16 and 17 These observations imply that airway remodeling might be due to worsening of airway inflammation associated with asthma exacerbations and support the paradigm that inflammation and remodeling occur in concert.16
For example, the Inhaled Steroid Treatment As Regular Treatment trial found that the decrease in lung function associated with exacerbations might be attenuated by ongoing treatment with low-dose ICSs.17 These clinical findings and those of Bai et al16 indicate that corticosteroids might affect remodeling, especially if administered during critical periods of asthma development and airway injury (ie, exacerbations). Therefore to appreciate the role and contribution of remodeling to asthma and the effects of treatment on these processes, our discussion will focus on individual aspects of remodeling and the effects of medication on these airway features. Although our discussion might focus on individual components of remodeling and the effects of treatment, it is more likely that the repair process involves multiple changes at the same time, and if an intervention is beneficial, the improvement might represent a broad-based effect.
What are the effects of corticosteroids on airway remodeling?Corticosteroids, either inhaled (ICSs) or systemic (oral corticosteroids), modulate acute and chronic inflammation in asthmatic subjects, particularly in those with milder disease, and have broad pharmacologic actions.14 and 15 Consequently, glucocorticoids are considered the therapeutic mainstay for chronic asthma and its underlying inflammation. Indeed, as a result of the “chronic inflammation leads to remodeling” paradigm, corticosteroids have long played a central role in interventional studies to assess the effect of treatment on airway remodeling in asthmatic subjects. However, the aforementioned recent childhood airway studies have cast doubt on this model. New evidence suggests remodeling might arise from asthma exacerbations and not chronic inflammation,5, 6, 7 and 8 and these events ultimately lead to an exaggerated decrease in lung function.16 and 17 These observations imply that airway remodeling might be due to worsening of airway inflammation associated with asthma exacerbations and support the paradigm that inflammation and remodeling occur in concert.16For example, the Inhaled Steroid Treatment As Regular Treatment trial found that the decrease in lung function associated with exacerbations might be attenuated by ongoing treatment with low-dose ICSs.17 These clinical findings and those of Bai et al16 indicate that corticosteroids might affect remodeling, especially if administered during critical periods of asthma development and airway injury (ie, exacerbations). Therefore to appreciate the role and contribution of remodeling to asthma and the effects of treatment on these processes, our discussion will focus on individual aspects of remodeling and the effects of medication on these airway features. Although our discussion might focus on individual components of remodeling and the effects of treatment, it is more likely that the repair process involves multiple changes at the same time, and if an intervention is beneficial, the improvement might represent a broad-based effect.
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