Airway smooth muscle (ASM) plays a pivotal role in modulating bronchomotor tone but also orchestrates and perpetuates airway inflammation and remodeling. Despite substantial research, there remain important unanswered questions. In 2006, the National Heart, Lung, and Blood Institute sponsored a workshop to define new directions in ASM biology. Important questions concerning the key functions of ASM include the following: Does developmental dysregulation of ASM function promote airway disease, what key signaling pathways in ASM evoke airway hyperresponsiveness in vivo, do alterations in ASM mass affect excitation-contraction coupling, and can ASM modulate airway inflammation and remodeling in a physiologically relevant manner? This workshop identified critical issues in ASM biology to delineate areas for scientific investigation in the identification of new therapeutic and diagnostic approaches in asthma, chronic obstructive pulmonary disease, and cystic fibrosis.Keywords: myocyte; signal transduction; force generation; migration; remodeling Diseases characterized by airway obstruction-namely, asthma, chronic bronchitis, emphysema, and cystic fibrosis-induce substantial morbidity and mortality in the United States. Although the precise mechanisms promoting airway obstruction in these common diseases remain unclear, airway smooth muscle (ASM) shortening likely plays a significant role in disease pathogenesis (1-3). Indeed, a mainstay in the treatment of airway obstruction is the use of bronchodilators, whose primary function is to relax ASM. Substantial progress in the past 20 years in ASM biology has identified ASM not only as modulating bronchomotor tone but as orchestrating and perpetuating inflammation and fibrosis in airway remodeling. As shown in Figure 1, ASM serves a variety of functions that are interrelated; however, in disease, bronchial smooth muscle may serve a distinct role in the pathogenesis. Despite existing controversy over the role of ASM function in health (4), few argue that, in the pathogenesis of diseases of airway obstruction, smooth muscle plays a pivotal role (5-7). Given the recent focus of ASM as a potential immunomodulatory cell as well as a cell important in airway remodeling, there remain substantial gaps in our understanding of ASM function. Furthermore, ASM cells manifest diverse phenotypes that induce functional plasticity concerning force generation, growth, and migration (8).New therapeutic approaches, such as bronchial thermoplasty, in part eliminate bronchial ASM (9). Although this therapy remains investigational, such approaches targeting the elimination of ASM will likely serve as useful experimental tools to address the relative contribution of ASM in modulating airway inflammation and remodeling.The goal of this perspective is not to provide an exhaustive compendium of studies in ASM biology in health and disease but to provide a focus for future studies that will enhance our understanding and provide new therapeutic targets in modulating myocyte function. The National Hea...