Airway Remodeling: An Important Reason to Work Toward Asthma Control

  • How to tell if your asthma is under control was the subject of one of my recent posts here. If you haven't read it, I highly recommend you do, because asthma control should be the overriding goal that guides you in how you live your life when you have asthma. Control is achievable for most everyone who must deal with this chronic illness, thanks to the wide variety of modern medical treatments.


    But what if you don't have your asthma under control? Perhaps one of these situations sounds familiar:

    • You don't take your controller medication/inhaler regularly, so you frequently have symptoms & must use your rescue inhaler to relieve them.
    • The controller medication you are on doesn't really keep your symptoms in check at this point.
    • You find it hard to avoid your asthma and/or allergy triggers, so even though you take controller medication, you still often have symptoms.

    Let's face it: Most asthmatics experience periods of poor asthma control from time to time. I know I do. For example, this time of year when weed pollens are at peak levels and I am actively involved in outdoor activities almost daily, I expect to have allergy and asthma symptoms. I can't really avoid them while living the lifestyle I have chosen, even though I am taking both my allergy and asthma medication every day.

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    I know, though, that my asthma control will improve as summer winds into fall and then winter. The same is true for most of us. As long as you have good asthma control most of the time, there is no need to worry.


    But when poor asthma control becomes a continuous or chronic problem that is left unchecked, it can result in a serious health risk that can threaten your long-term prognosis.


    Chronic Issues With Asthma Control


    When you have asthma symptoms and control has slipped, it means your airways are inflamed, or irritated. When poor asthma control persists, there will always be a certain level of airway inflammation. After a while, your body tries to "fix" this inflammation by triggering the following structural changes in your airways:

    • A thickening of the airway walls, involving both your muscle and collagen tissue
    • More smooth muscle cells in the lining of the airways
    • An increase in the number of mucous glands and amount of mucous produced by the airways
    • A spike in the vascularity, or blood supply, in your airways

    And the bad news is once these changes occur, they cannot be reversed, and they will result in a loss of function in your airways, triggering even more breathing problems. In effect, your airways become stiffer and narrower, making it harder to get air into and out of your lungs.


    So, it should be obvious that most people would want to avoid airway remodeling from happening.


    Other Possible Risk Factors for Airway Remodeling


    We know for sure that chronic airway inflammation is the biggest risk factor for developing airway remodeling, and people with the classification of severe persistent asthma are the group most likely to have this chronic inflammation.


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    Although there is still much debate about the specifics of what leads to airway remodeling, many experts believe the following are risk factors as well:

    • Length of time you have had asthma
    • How old you were when you developed asthma
    • Certain genetic predispostions
    • Repeated environmental exposure to allergens/triggers

    Steps to Take to Help Prevent Airway Remodeling


    I am not trying to scare you. Most people who have asthma live long healthy lives and are able to carry on with the lifestyles they choose, at least most of the time. But when asthma control slips — and is not regained in a reasonably short time — there should be cause for concern.


    So, keep in mind that effective treatment of your asthma that provides consistent asthma control is essential in helping to prevent airway remodeling. Work closely with your health care team to make this happen.


    1. Take your medicine as prescribed. If you're having symptoms regularly and you're not on a controller medicine, talk with your doctor about the possibility. Don't just keep using your rescue inhaler all the time. That provides temporary relief, not long-term control.


    2. Do everything you can to avoid your known asthma and allergy triggers. Repeated exposure to triggers leads to an increased number and frequency of asthma attacks (i.e., severe airway inflammation).


    3. Stay on top of your Asthma Action Plan. If you are having symptoms frequently, even when taking asthma medicine, then it's time to talk with your doctor about modifying your asthma treatment plan. What you're doing and taking isn't working and that should send up red flags.


    Treating asthma effectively can be somewhat of a trial-and-error process at times. Not everyone responds to medication in the same ways. Doctors may need to mix and match different types of asthma medication or try a different brand. It's your responsibility to advocate for yourself and let the doctor know when something isn't working well.

Published On: September 02, 2013