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Small airway inflammation in asthma

BioMed Central
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  • Review
  • Biology
  • Medicine


com m entary review reports research article BDP = beclomethasone dipropionate; GR = glucocorticoid receptor; IFN = interferon; IL = interleukin; Kd = dissociation constant; MDI = metered- dose inhalers; NA = nocturnal asthma; NNA = non-nocturnal asthma. Available online Introduction Asthma is a complex, chronic inflammatory lung disease that is characterized by epithelial shedding, airway smooth muscle hypertrophy and hyperplasia, overproduction of mucus, and airway inflammation. The pathophysiology of asthma has traditionally been attributed to an inflammatory process that occurs predominantly in the large airways [1]. Early studies, conducted over 100 years ago, used autopsy specimens to study the macroscopic morphologi- cal and histological changes that occur within the large asthmatic airways [1]. Those studies clearly showed that asthma involves structural airway changes, including increased size and amount of airway smooth muscle, thickened basement membrane, mucus hypersecretion and oedema in the airway wall. The application of fibreoptic bronchoscopy in asthma has enabled us to obtain small human endobronchial biopsies from the large airways. This, together with the development of molecular biology technologies (i.e. immunocytochem- istry and in situ hybridization), has advanced our under- standing of the pathogenesis of bronchial asthma [2,3]. Studies using surgically resected lung tissue [4–6], autopsy lung specimens [7–9] and transbronchial biop- sies [10,11] indicated that similar but more severe inflam- matory and structural changes also occur in the small airways [8,12,13] and in lung parenchyma [10] of asth- matic persons. These findings may be extremely important, because the total volume and the combined surface area of the small airways are much greater than the surface area of the large airways [14]. Currently, the therapeutic challenge is to develop better inhalation technologies in order to improve delivery of

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