Biologics and airway remodeling in severe asthma

Asthma is a chronic inflammatory airway disease resulting in airflow obstruction, which in part can become irreversible to conventional therapies, defining the concept of airway remodeling. The introduction of biologics in severe asthma has led in some patients to the complete normalization of previ...

Full description

Saved in:
Bibliographic Details
Published in:Allergy (Copenhagen) 2022-12, Vol.77 (12), p.3538-3552
Main Authors: Varricchi, Gilda, Ferri, Sebastian, Pepys, Jack, Poto, Remo, Spadaro, Giuseppe, Nappi, Emanuele, Paoletti, Giovanni, Virchow, Johann Christian, Heffler, Enrico, Canonica, Walter G.
Format: Article
Language:English
Subjects:
Airway Obstruction
Airway Remodeling
Allergic diseases
Allergies
Asthma
Asthma - drug therapy
Asthma - etiology
Biological products
Biological Products - pharmacology
Biological Products - therapeutic use
biologics
biomarkers
Cytokines
Environmental factors
Glucocorticoids
Humans
immunotherapies
Immunotherapy
Lung
Pulmonary Disease, Chronic Obstructive
Respiratory function
Respiratory tract diseases
Review
severe asthma
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Asthma is a chronic inflammatory airway disease resulting in airflow obstruction, which in part can become irreversible to conventional therapies, defining the concept of airway remodeling. The introduction of biologics in severe asthma has led in some patients to the complete normalization of previously considered irreversible airflow obstruction. This highlights the need to distinguish a “fixed” airflow obstruction due to structural changes unresponsive to current therapies, from a “reversible” one as demonstrated by lung function normalization during biological therapies not previously obtained even with high‐dose systemic glucocorticoids. The mechanisms by which exposure to environmental factors initiates the inflammatory responses that trigger airway remodeling are still incompletely understood. Alarmins represent epithelial‐derived cytokines that initiate immunologic events leading to inflammatory airway remodeling. Biological therapies can improve airflow obstruction by addressing these airway inflammatory changes. In addition, biologics might prevent and possibly even revert “fixed” remodeling due to structural changes. Hence, it appears clinically important to separate the therapeutic effects (early and late) of biologics as a new paradigm to evaluate the effects of these drugs and future treatments on airway remodeling in severe asthma.
ISSN:0105-4538
1398-9995
DOI:10.1111/all.15473