Am. J. Respir. Crit. Care Med., Volume 164, Number 9, November 2001, 1718-1721

Reduced Airway Distensibility, Fixed Airflow Limitation, and Airway Wall Remodeling in Asthma

CHRIS WARD, DAVID P. JOHNS, ROS BISH, MIKE PAIS, DAVID W. REID, CORRIE INGRAM, BRYCE FELTIS, and E. HAYDN WALTERS

Department of Respiratory Medicine, Alfred Hospital and Monash University Medical School, Melbourne, Australia; Discipline of Medicine, University of Tasmania, Medical School, Hobart, Tasmania, Australia; and William Leech Centre Freeman Road Hospital, University of Newcastle upon Tyne, United Kingdom

The airways of individuals with asthma are less distensible than normal and it has been assumed that this may be due to airway remodeling associated with chronic inflammation, although there are currently no available data directly relating these two aspects of asthma. We have therefore carried out a study of the relationship between airway distensibility (VD) and subepithelial reticular basement membrane (RBM) thickening as an index of airway remodeling, in a group of patients with relatively mild but symptomatic asthma. Our methods included a cross-sectional study of VD in patients with mild to moderate atopic asthma, with matched airway biopsy for structural components. We confirmed that VD was lower in patients with asthma than in normal individuals (19.8 ± 1.1 versus 24.1 ± 1.5; p < 0.05) and that RBM thickness was increased in patients with asthma (9.1 ± 2.2 versus 7.7 ± 1.2 µm; p < 0.01). There was a negative correlation between VD and RBM thickness in asthma (r = 0.37, p = 0.03) and positive correlations between percent predicted postbronchodilator large and small airway function (for percent predicted FEV₁ versus VD, r = 0.59, p < 0.001). We conclude that, cross-sectionally, VD was related to airway remodeling (RBM thickening) and airflow limitation (percent predicted large and small airway function). Our findings support the hypothesis that VD is a physiologic test that is reflective of airway remodeling.

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