Nonpharmacological and pharmacological interventions to prevent or reduce airway remodelling

Abstract

In the present review of airway remodelling and its response to therapies, clinical observations about airway physiological abnormalities, assumed to be caused by remodelling processes, are related to what is known about the components of structural changes from airway sampling and histopathological analysis. The review focuses on three important diseases: asthma, chronic obstructive pulmonary disease and bronchiolitis obliterans syndrome (BOS), which occurs commonly after lung transplantation as a manifestation of chronic rejection. The present authors chose to use BOS as an issue, because with routine bronchoscopic surveillance after lung transplantation there has been more opportunity to directly study airway pathology longitudinally than in more everyday conditions. In addition, the present authors have reviewed animal models of induced airway remodelling, where most information is available on the potential of therapeutic intervention. Finally, the limited information that can be gained from the literature on the effects of commonly used airway medications on remodelling components is reviewed. In conclusion, the present authors have detailed some of the gaps in knowledge surrounding the potential to improve or modulate remodelling processes in human disease. The areas where it is believed urgent research needs to be focused have also been highlighted.

The Brussels Declaration: the need for change in asthma management

“…Recent reviews suggest that evidence that any current treatment can prevent or reduce airway remodelling is conflicting at best [9,40], and there is an urgent need for research in this area. A better understanding of the root cause of inflammation should lead to the development of both curative treatments and effective prevention strategies.…”

Airway remodelling: the future

“…Lifestyle changes, such as smoking cessation, prevention of infections or modulating immune responses, as well as reduction of exposure to potential environmental hazards, such as allergens and pollutants, both at home or at the workplace, may help to reduce airway remodelling but are often difficult to achieve [6,34,35]. Animal models showed that early interventions, such as with inhaled corticosteroids or leukotriene receptor antagonists, may prevent many aspects of airway remodelling, at least partly [3,7,8].…”

“…There is evidence both from animal models and human clinical trials that environmental or pharmacological interventions may reduce various aspects of airway remodelling [6,34,35].…”

“…During the past months, the European Respiratory Journal has published a series on airway remodelling in order to review the state of knowledge in this increasingly important domain [2][3][4][5][6]. We learnt from this series that airway remodelling is by no means a single entity.…”

Montelukast in the treatment of asthma and beyond

“…Apart from modulating the bronchoactive and proinflammatory effects of CysLTs, LTRA may also protect against several aspects of CysLT-induced airway hyperresponsiveness and airway remodeling [66,67], as CysLT 1 Rs have been found on the airway smooth muscle in both central and peripheral airways [25]. In line with these findings, in a study by Riccioni and colleagues, 12 weeks of treatment with montelukast (10 mg once daily) both as monotherapy and in combination with inhaled corticosteroids (budesonide 400 µg twice daily) decreased airway hyperresponsiveness in patients with mild-to-moderate persistent asthma [68].…”