[Remodelling in obturative diseases and treatment].

The inflammatory process in asthma and COPD are involved in remodelling of airways. It has been suggested that the clinically observed distinctions between these two diseases are reflected by differences in structural changing of the airways. In asthma the epithelium appears to be more fragile than that of chronic obstructive pulmonary disease (COPD), the epithelial reticular basement membrane (RBM) is significantly thicker, and there is marked enlargement of the mass of bronchial smooth muscle. In COPD it has been observed epithelial mucous metaplasia, airway wall fibrosis, and the inflammation is associated with loss of surrounding alveolar attachments. The remodelling of bronchial wall in asthma can be assessed using the histological examination of bronchial biopsies, high-resolution computed tomography (HRCT) and endobronchial ultrasound (EBUS). The assessment of air trapping in HRCT is an important tool in the evaluation of irreversible airway changes in asthmatics. Diffuse air trapping markedly correlates with bronchial thickness and probably reflects remodelling in the entire bronchial tree. EBUS also allows precise distinguishing and measurement of the thickness and wall area of bronchial wall layers. The results of recently published studies suggest the possibility of employing EBUS to remodelling assessment. Until now there are unknown any effective pharmacology methods to treat of remodelling in asthma. Bronchial thermoplasty (BT) is a novel intervention for asthma that delivers controlled thermal energy to the airway wall during bronchoscopy resulting in a prolonged reduction of airway smooth muscle mass and may allow to treat the remodelling in asthma.