Remodeling in Asthma and Chronic Obstructive Lung Disease
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- 15 November 2001
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 164 (supplement), S28-S38
- https://doi.org/10.1164/ajrccm.164.supplement_2.2106061
Abstract
Asthma and chronic obstructive lung disease (COPD) are both inflammatory conditions of the lung associated with structural "remodeling" inappropriate to the maintenance of normal lung function. The clinically observed distinctions between asthma and COPD are reflected by differences in the remodeling process, the patterns of inflammatory cells and cytokines, and also the predominant anatomic site at which these alterations occur. In asthma the epithelium appears to be more fragile than that of COPD, the epithelial reticular basement membrane (RBM) is significantly thicker, there is marked enlargement of the mass of bronchial smooth muscle, and emphysema does not occur in the asthmatic nonsmoker. In COPD, there is epithelial mucous metaplasia, airway wall fibrosis, and inflammation associated with loss of surrounding alveolar attachments to the outer wall of small airways: bronchiolar smooth muscle is increased also. Emphysema is a feature of severe COPD: in spite of the destructive process, alveolar wall thickening and focal fibrosis may be detected. The hypertrophy of submucosal mucus-secreting glands is similar in extent in asthma and COPD. The number of bronchial vessels and the area of the wall occupied by them increase in severe corticosteroid-dependent asthma: it is likely that these increases also occur in severe COPD as they do in bronchiectasis. Pulmonary vasculature is remodeled in COPD. In asthma several of these structural alterations begin early in the disease process, even in the child. In COPD the changes begin later in life and the associated inflammatory response differs from that in asthma. The following synopsis defines and compares the key remodeling processes and proposes several hypotheses.Keywords
This publication has 62 references indexed in Scilit:
- Local anaesthetic effect of topical amethocaine gel in neonates: randomised controlled trialArchives of Disease in Childhood: Fetal & Neonatal, 2000
- Inflammation of small airways in asthma☆☆☆★★★Journal of Allergy and Clinical Immunology, 1997
- Bronchial vascular congestion and angiogenesisEuropean Respiratory Journal, 1997
- Continuity of airway goblet cells and intraluminal mucus in the airways of patients with bronchial asthmaEuropean Respiratory Journal, 1996
- Collagen content of alveolar wall tissue in emphysematous and non-emphysematous lungs.Thorax, 1994
- Pulmonary vascular structure and function in chronic obstructive pulmonary disease.Thorax, 1988
- The Relations between Structural Changes in Small Airways and Pulmonary-Function TestsNew England Journal of Medicine, 1978
- Hyperplasia of bronchial muscle in asthmaThe Journal of Pathology, 1973
- A comparison of the quantitative anatomy of the bronchi in normal subjects, in status asthmaticus, in chronic bronchitis, and in emphysemaThorax, 1969
- PATHOLOGY OF CHRONIC BRONCHITISThe Lancet, 1954