Remodeling of the Airways

Asthma is a chronic disease that can lead to permanent lung damage. Permanent changes in the airways appear to result from repeated asthmatic events causing recurrent bouts of inflammation of the bronchi which in turn can ultimately lead to airway fibrosis (scarring) and permanent narrowing of the airways (remodeling). Once fibrosis occurs, it cannot be reversed with treatment. Permanent damage to the airways usually occurs very slowly over a very long time. Effectively treating asthma during acute episodes, while undertreating the disease when your symptoms are less severe, may lead to serious long term non-reversible lung disease. Unfortunately, it is not possible to know in advance whether you have the potential to develop permanent damage.

The concept of permanent narrowing of the airways resulting from inflammation and fibrosis is called remodeling. Poorly controlled asthma is thought to be a dynamic (changing) disease that can evolve from fully reversible bronchospasm to permanent narrowing of the airways. In some ways, airway remodeling may appear similar to the fixed airway obstruction seen in chronic obstructive pulmonary disease (COPD). However, COPD is not asthma, even if the symptoms initially appear similar. The causes of COPD and asthma are quite different even though the symptoms can be similar.

In the past, some pediatricians have told children and their parents that the children would outgrow their asthma. Although many pediatric asthmatic patients do, in fact, appear to be cured of asthma, millions of other childhood asthmatic patients continue to experience asthmatic symptoms as adults. In children with asthma, early and aggressive treatment of the inflammatory process of asthma may be the most important factor in preventing airway remodeling and permanent damage.