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Biologics and Airway Remodeling in Asthma: Early, Late and Potential
Preventive Effects
Abstract
Although airway remodeling in severe and/or fatal asthma is still
considered irreversible, its individual components as a cause of
clinical symptoms and/or lung function changes remain largely unknown.
While inhaled glucocorticoids have not consistently been shown to affect
airway remodeling, biologics targeting specific pathways of airway
inflammation have been shown to improve lung function, mucus plugging,
and airway structural changes that can exceed those seen with
glucocorticoids. This superiority of biologic treatment, which cannot be
solely explained by insufficient doses or limited durations of
glucocorticoid therapies, needs to be further explored. For this field
of research, we propose a novel classification of the potential effects
of biologics on airway remodeling into 3 temporal effects: early
effects (days to weeks, primarily modulating inflammatory processes),
late effects (months to years, predominantly affecting structural
changes) and potential preventive effects (outcomes of early
treatment with biologics). For the identification of potential
preventive effects of biologics, we call for studies exploring
the impact of early biological treatment on airway remodeling in
patients with moderate-to-severe asthma, which should be accompanied by
a long-term evaluation of clinical parameters, biomarkers, treatment
burden, and socioeconomic implications.