What Is the Clinical Relevance of Airway Remodeling? Many of the changes described above are part of an abnormal or exaggerated response to an airway insult, and the type and time-course of these alterations will vary according to the type of offending agent, the duration of the process, and the genetic predisposition of the individual for such a response. Airway remodeling, as bronchial inflammation, may be observed in the absence of clinical manifestations, and there may be a threshold after which their combined influence on airway function will be sufficient to induce respiratory symptoms; in asthma, this may occur after a period of subclinical AHR. Reading here
The clinical relevance of the various airway structural changes remain to be determined, and the correlations with epidemiologic data remain unclear. Although some changes may be protective, they most probably contribute to the persistence of altered airway physiology, particularly AHR, an accelerated decline in lung function, and the development of an irreversible component of airway obstruction. For a certain degree of remodeling, however, changes in the contractile properties of the airways and inflammation may modulate the expression of the disease.
It remains possible that if we could block the remodeling response to inflammatory processes, the development of diseases such as asthma or COPD could be prevented. Nevertheless, these hypotheses remain to be explored. Apart from inhibiting inflammation, it is possible that in the future, the transition toward remodeling will be preventable by pharmacologic interventions or gene therapy. Control of persistent asthma can be usually achieved by early treatment and maintenance therapy with ICS. Some evidence supports the role of ICS in preventing or reducing the decline of airway function in asthmatic patients, with a greater benefit if therapy with ICS is started early after asthma diagnosis.