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Role of Inhaled Steroids in Vascular Airway Remodelling in Asthma and COPD.

Chetta A, Olivieri D - Int J Endocrinol (2012)

Bottom Line: Vascular changes may significantly contribute to airway wall remodelling.Additionally, studies on combination therapy with long-acting β2-agonists and inhaled steroids have provided evidence of a possible synergistic action on components of vascular remodelling in asthma.The inhibition of VEGF and its receptor may be useful in the treatment of the vascular changes in the airway wall.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Padiglione Rasori, Azienda Ospedaliero-Universitaria, Viale Rasori 10, 43125 Parma, Italy.

ABSTRACT
In chronic obstructive airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD), changes in bronchial microvasculature are present in response to inflammatory stimuli. Vascular changes may significantly contribute to airway wall remodelling. Angiogenesis and vascular leakage are prevalent in asthma, while vasodilation and vascular leakage dominate in COPD. An endothelial dysfunction may be present both in asthma and in COPD. Vascular changes may occur simultaneously with the thickening of the airway wall and the narrowing of the bronchial lumen. Consequently, pharmacological control of bronchial vascular remodelling may be crucial for symptom control in asthma and COPD. In asthmatic airways, inhaled steroids can downregulate vascular remodelling by acting on proangiogenic factors. Additionally, studies on combination therapy with long-acting β2-agonists and inhaled steroids have provided evidence of a possible synergistic action on components of vascular remodelling in asthma. In COPD, there is less experimental evidence on the effect of inhaled steroids on airway microvascular changes. Importantly, vascular endothelial growth factor (VEGF), the most specific growth factor for vascular endothelium, is crucially involved in the pathophysiology of airway vascular remodelling, both in asthma and COPD. The inhibition of VEGF and its receptor may be useful in the treatment of the vascular changes in the airway wall.

No MeSH data available.


Related in: MedlinePlus

Schematic representation of bronchial airways wall. In asthma and COPD changes in bronchial microvasculature, such as angiogenesis, vasodilatation, and microvascular leakage, are present in response to inflammatory stimuli. Considering conventional therapy, only corticosteroids can positively act on all aspects of vascular remodelling.
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Related In: Results  -  Collection


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fig1: Schematic representation of bronchial airways wall. In asthma and COPD changes in bronchial microvasculature, such as angiogenesis, vasodilatation, and microvascular leakage, are present in response to inflammatory stimuli. Considering conventional therapy, only corticosteroids can positively act on all aspects of vascular remodelling.

Mentions: Airway wall remodelling is a distinctive feature of bronchial asthma [6]. In asthmatic airways, structural changes occur in all three layers of the airway wall: the inner wall, the outer wall, and the smooth-muscle layer (Figure 1). Basically, the remodelling consists in the shedding of the epithelium, the increase in mucous glands, thickening of the reticular basement membrane, hypertrophy and hyperplasia of airway smooth muscle, and in qualitative and quantitative changes in airway blood vessels [7].


Role of Inhaled Steroids in Vascular Airway Remodelling in Asthma and COPD.

Chetta A, Olivieri D - Int J Endocrinol (2012)

Schematic representation of bronchial airways wall. In asthma and COPD changes in bronchial microvasculature, such as angiogenesis, vasodilatation, and microvascular leakage, are present in response to inflammatory stimuli. Considering conventional therapy, only corticosteroids can positively act on all aspects of vascular remodelling.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3475307&req=5

fig1: Schematic representation of bronchial airways wall. In asthma and COPD changes in bronchial microvasculature, such as angiogenesis, vasodilatation, and microvascular leakage, are present in response to inflammatory stimuli. Considering conventional therapy, only corticosteroids can positively act on all aspects of vascular remodelling.
Mentions: Airway wall remodelling is a distinctive feature of bronchial asthma [6]. In asthmatic airways, structural changes occur in all three layers of the airway wall: the inner wall, the outer wall, and the smooth-muscle layer (Figure 1). Basically, the remodelling consists in the shedding of the epithelium, the increase in mucous glands, thickening of the reticular basement membrane, hypertrophy and hyperplasia of airway smooth muscle, and in qualitative and quantitative changes in airway blood vessels [7].

Bottom Line: Vascular changes may significantly contribute to airway wall remodelling.Additionally, studies on combination therapy with long-acting β2-agonists and inhaled steroids have provided evidence of a possible synergistic action on components of vascular remodelling in asthma.The inhibition of VEGF and its receptor may be useful in the treatment of the vascular changes in the airway wall.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Padiglione Rasori, Azienda Ospedaliero-Universitaria, Viale Rasori 10, 43125 Parma, Italy.

ABSTRACT
In chronic obstructive airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD), changes in bronchial microvasculature are present in response to inflammatory stimuli. Vascular changes may significantly contribute to airway wall remodelling. Angiogenesis and vascular leakage are prevalent in asthma, while vasodilation and vascular leakage dominate in COPD. An endothelial dysfunction may be present both in asthma and in COPD. Vascular changes may occur simultaneously with the thickening of the airway wall and the narrowing of the bronchial lumen. Consequently, pharmacological control of bronchial vascular remodelling may be crucial for symptom control in asthma and COPD. In asthmatic airways, inhaled steroids can downregulate vascular remodelling by acting on proangiogenic factors. Additionally, studies on combination therapy with long-acting β2-agonists and inhaled steroids have provided evidence of a possible synergistic action on components of vascular remodelling in asthma. In COPD, there is less experimental evidence on the effect of inhaled steroids on airway microvascular changes. Importantly, vascular endothelial growth factor (VEGF), the most specific growth factor for vascular endothelium, is crucially involved in the pathophysiology of airway vascular remodelling, both in asthma and COPD. The inhibition of VEGF and its receptor may be useful in the treatment of the vascular changes in the airway wall.

No MeSH data available.


Related in: MedlinePlus