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Annals of Clinical & Laboratory Science 34:138-142 (2004)
© 2004 Association of Clinical Scientists

Review

Pharmacological Treatment of Airway Remodeling: Inhaled Corticosteroids or Antileukotrienes?

Graziano Riccioni, Carmine Di Ilio and Nicolantonio D’Orazio
Unit of Human Nutrition, Department of Biomedical Sciences, D’Annunzio University, Chieti, Italy

Address correspondence to Graziano Riccioni MD, Via F. Ferri 90, 66100 Chieti, Italy; tel 39 871 333 636 6661; fax 39 871 355 6705; e-mail: griccioni{at}hotmail.com.

Chronic stable asthma is characterized by inflammation of the airway wall, with abnormal accumulation of basophils, eosinophils, lymphocytes, mast cells, macrophages, dendritic cells, and myofibroblasts. Airway inflammation is not limited to severe asthma, but is also found in mild and moderate asthma. This inflammation results in a peculiar type of lymphocytic infiltration whereby Th2 lymphocytes secrete cytokines that orchestrate cellular inflammation and promote airway hyper-responsiveness. The term "airway remodeling" in bronchial asthma refers to structural changes that occur in conjunction with, or because of, chronic airway inflammation. Airway remodeling results in alterations in the airway epithelium, lamina propria, and submucosa, leading to thickening of the airway wall. Consequences of airway remodeling in asthma include incompletely reversible airway narrowing, bronchial hyper-responsiveness, airway edema, and mucus hypersecretion; these effects may predispose subjects with asthma to exacerbations and even death due to airway obstruction. To avoid this progression, it is important to follow an adequate treatment aimed at interacting and modifying the inflammatory process. Inhaled corticosteroids remain the cornerstone of asthma management. Altough several drugs, such as ketotifen, sodium cromoglycate, sodium nedocromil, and theophylline have anti-inflammatory properties, they are less effective than corticosteroids. Anti-leukotrienes are a new class of anti-inflammatory drugs that interfere directly with leukotriene receptors. The aim of this brief review is to delineate the effects of inhaled corticosteroids and antileukotriene drugs on inflammation and remodeling.

Keywords: airway inflammation, remodeling, bronchial hyper-responsiveness, asthma, cytokines, inhaled corticosteroids, antileukotrienes, montelukast, zafirlukast, budesonide






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