The Effect of Inhaled Budesonide and Formoterol on Bronchial Remodeling and HRCT Features in Young Asthmatics

Abstract

Asthma is a chronic disease that may cause remodeling of the airways. We aimed to observe the effects of the combined use of inhaled budesonide and formoterol on both the reversibility of remodeling and structural changes in the airways. Thirty-six male patients (age range, 20-31) with mild-to-moderate persistent asthma were given inhaled formoterol and budesonide treatment for three months. Bronchial diameter (BD) and bronchial wall thickness (BWT), as measured by high-resolution computerized tomography, and reticular basement membrane thickness (RBMT), assessed in bronchoscopic biopsy specimens, were compared with pretreatment findings. Twenty-two age-matched male controls were also enrolled. BDs of the patients were significantly smaller than in the controls, whereas BWT and RBMT were greater. After three months BWT and RBMT of the subsegmental airways significantly decreased and BD increased. There was a prominent eosinophilic and lymphocytic infiltration in the bronchial mucosa of the asthmatics, and the eosinophilic infiltration significantly improved with treatment. Both serum total IgE and eosinophil counts were related to eosinophilic infiltration in the biopsy samples (r = 0.494 and r = 0.463, respectively). FEV(1) was positively correlated with the diameters of the segmental and subsegmental airways (r = 0.491 and r = 0.265, respectively) and negatively correlated with BWT of the subsegmental airways (r = -0.293) and with the RBMT of both the segmental and subsegmental airways (r = -0.597 and r = -0.590, respectively). We suggest that treatment with inhaled formoterol and budesonide may reverse increased RBMT and BWT as part of remodeling in patients with asthma.

Airway remodeling in subjects with severe asthma with or without chronic persistent airflow obstruction

“…Although the power to detect a difference was low in this study, our findings are consistent with the findings of Little et al 29 A correlation between RBM thickness and airway wall thickness has been reported in a group of adult subjects with mild-to-moderate asthma 30 but not in children. 31 Of note, treatment with inhaled steroids decreases wall thickness, 32,33 an effect that might be reflected in our findings. The apparent contradiction in the literature regarding HRCT in subjects with asthma 29,34-36 might be due to different patient populations sampled, disease duration, treatment history, and different measurement techniques.…”

“…This remains to be proved for the changes in ASM but has already been shown for the RBM and the vascular component. 27,33 We measured several mediators in sputum supernatants to explore, in a preliminary manner, molecular determinants of active remodeling. ECP and IL-5 levels correlated with SMA, suggesting that eosinophilic (T H 2) inflammation might favor SMA remodeling, as it might favor other aspects of remodeling.…”

New insights into airway remodelling in asthma and its possible modulation

“…Many in vivo studies have examined the putative antiremodelling effect of ICS: they might reverse increased reticular basement membrane and bronchial wall thickness in patients with asthma [56] and decrease as well the expression of a-SMA in peripheral airways and submucosal vascularity [57,58].…”

Pharmacological Modulation of the Bradykinin-Induced Differentiation of Human Lung Fibroblasts: Effects of Budesonide and Formoterol

“…However, it was shown recently that the combination therapy of the ICS budesonide (BUD) and the LABA formoterol (FM) significantly attenuated the number of submucosal tissue myofibroblasts enhanced after allergen inhalation (15). Furthermore, BUD-FM combination therapy was shown to decrease the thickness of reticular basement membrane and bronchial wall in patients with asthma (16). It is not known whether cellular and intracellular pathways are involved in these effects.…”