Purpose of review: Remodeling and inflammation together with airway hyperresponsiveness are essential components of asthma but their role in development of the disease is still obscure.
Recent findings: Recent data imply that remodeling can occur early in childhood, not necessarily subsequent to but rather, in parallel with inflammation. The assumption of thickening of the reticular basement membrane being a prerequirement for chronic asthma is questioned but development of airway responsiveness is a significant factor. Airway responsiveness is at least partially linked to bronchial inflammation but there are several other genes and pathways regulating airway responsiveness. Increased airway smooth muscle in early childhood is associated with later development of asthma and may be one link between inflammation and airway responsiveness. Novel findings on genetic variation in genes regulating lung growth and remodeling in early childhood shed light on the pathophysiological mechanisms leading to chronic asthma.
Summary: Even young children with chronic asthma have detectable elements of airway remodeling, inflammation and increased airway responsiveness, which all contribute to impaired lung function.