Chronic inflammation of the asthmatic airway leads to epithelial desqu
amation, goblet cell hyperplasia, mucosal and submucosal inflammation,
prominent smooth muscle, and collagen deposition below the basement m
embrane. The changes in the airway are attributed to chronic inflammat
ion, the healing process and subsequent remodeling. These changes cont
ribute to three predominant mechanisms of increased airway resistance
in asthma: decreased elastance of airways; increased smooth muscle in
the airway which may cause increased narrowing during bronchospasm; an
d collagen deposition beneath the basement membrane resulting in airwa
y wall thickening. Destruction and subsequent remodeling of the normal
bronchial architecture are manifested by a progressive decline in FEV
1. In an attempt to decrease the progressive decline in FEV1, studies
on proper therapy have been undertaken. Antiinflammatory medications,
such as inhaled corticosteroids, have been shown to decrease this rate
of decline in lung function, while the effect of bronchodilators is l
ess conclusive. Beginning treatment with inhaled corticosteroids early
produces a better clinical response compared to initiating treatment
late, and early treatment may prevent airway remodeling and developmen
t of irreversible structural changes.