Mechanism of allergic diseases

Remodeling in asthma.
Al-Muhsen S, Johnson JR, Hamid Q. J Allergy Clin Immunol. 2011 Sep;128(3):451-62.

Noneosinophilic asthma in children: relation with airway remodelling.
Baraldo S et al. Eur Respir J. 2011 Sep;38(3):575-83.

Sergio Uribe

Programa de Doctorado en Ciencias Médicas Facultad de Medicina Universidad Austral de Chile

Every day in America: 40,000 people miss school or work due to asthma. 30,000 people have an asthma attack. 5,000 people visit the emergency room due to asthma. 1,000 people are admitted to the hospital due to asthma. 11 people die from asthma http://www.aafa.org/display.cfm?id=8&sub=42

Valdivia C et al . Changes in asthma prevalence among school children during a 6 -year period: Influence of socioeconomic status. Rev. méd. Chile. 2009 Feb; 137(2): 215-225.

Burmester, Color Atlas of Immunology © 2003 Thieme

Burmester, Color Atlas of Immunology © 2003 Thieme

Burmester, Color Atlas of Immunology © 2003 Thieme

8, 193-204 (March 2008)

TISSUE REMODELING Remodeling in general Airway remodeling

HISTOPATHOLOGIC FEATURES OF REMODELING IN ASTHMATIC PATIENTS Epithelial alterations Mucus secretion and goblet cells Subepithelial fibrosis Increased smooth muscle mass Angiogenesis

MECHANISMS OF AIRWAY REMODELING

Inflammation Epithelial injury Cell-cell interactions Inflammatory mediators Imbalance between repair and removal of ECM proteins

MECHANISMS OF AIRWAY REMODELING

Inflammation Epithelial injury Cell-cell interactions Inflammatory mediators Imbalance between repair and removal of ECM proteins

CLINICAL RELEVANCE OF REMODELING IN ASTHMATIC PATIENTS

Structural-physiologic relationship Asthma exacerbation and remodeling Viral infection and remodeling Tobacco smoking and remodeling Natural history of airway remodeling Therapeutic interventions and remodeling Tools to measure airway remodeling (OCT

Schematic diagram of the OCT imaging system.

Xi C et al. PNAS 2004;101:7516-7521

©2004 by National Academy of Sciences

Optical coherence tomography image of early hilar-type lung cancer.

Kaneko M Jpn. J. Clin. Oncol. 2010;40:838-845
© The Author (2010). Published by Oxford University Press. All rights reserved

METHODS

Subjects

In conclusion, this study demonstrates that, even among children, a considerable proportion of asthmatics do not have evidence of tissue eosinophilia. Interestingly, the typical airway remodelling is present in children with noneosinophilic asthma just as in those with the eosinophilic form of the disease. These results suggest that structural changes develop early in the airways of children with asthma, and eosinophilic inflammation is not a necessary requirement.

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