Asthma: A disease characterised by excessive and variable airway narrowing, and pathologies of inflammation and remodelling, particularly thickening of the airway smooth muscle (ASM). Treatment approaches dilate narrowed airways and reduce inflammation; however, remodelling seems largely neglected. This review considers the evolution of remodelling in asthma and whether conventional hypotheses that inflammation causes ASM thickening has mislead the medical community into thinking that anti-inflammatories will remedy this ASM defect. There is instead reasonable evidence that ASM thickening occurs independently of inflammation, such that therapies should employ strategies to directly modify ASM growth. Lessons have been learned from the use of untargeted bronchial thermoplasty and there should also be consideration of pharmacological therapies to ablate ASM. We discuss several new approaches to target ASM remodelling in asthma. A major current obstacle is our inability to image the ASM layer and assess treatment response. In this regard, polarisation-sensitive optical coherence tomography offers future promise.

哮喘：以过度和可变的气道狭窄为特征，以及炎症和重塑的病理特征，特别是气道平滑肌（ASM）增厚的疾病。治疗方法可扩张狭窄的气道并减轻炎症；但是，重塑似乎在很大程度上被忽略了。这篇综述考虑了哮喘重塑的演变，以及炎症导致ASM增厚的传统假设是否误导了医学界，认为抗炎药可以纠正这一ASM缺陷。相反，有合理的证据表明ASM增厚独立于炎症而发生，因此治疗应采用直接改变ASM生长的策略。从非靶向性支气管热成形术的使用中已经吸取了教训，还应考虑采用药物治疗来消融ASM。我们讨论了针对哮喘中ASM重塑的几种新方法。当前的主要障碍是我们无法成像ASM层和评估治疗反应。在这方面，偏振敏感的光学相干断层扫描技术提供了未来的希望。