Although airway remodeling in severe and/or fatal asthma is stil considered irreversible, its individual components as a cause of clinical symptoms and/or lung function changes remain largely unknown. While inhaled glucocorticoids have not consistently been shown to affect airway remodeling, biologics targeting specific pathways of airway inflammation have been shown to improve lung function, mucus plugging, and airway structural changes that can exceed those seen with glucocorticoids. This superiority of biologic treatment, which cannot be solely explained by insufficient doses or limited durations of glucocorticoid therapies, needs to be further explored. For this field of research, we propose a novel classification of the potential effects of biologics on airway remodeling into three temporal effects: early effects (days to weeks, primarily modulating inflammatory processes), late effects (months to years, predominantly affecting structural changes), and potential preventive effects (outcomes of early treatment with biologics). For the identification of potential preventive effects of biologics, we call for studies exploring the impact of early biological treatment on airway remodeling in patients with moderate‐to‐severe asthma, which should be accompanied by a long‐term evaluation of clinical parameters, biomarkers, treatment burden, and socioeconomic implications.

中文翻译：

---

哮喘中的生物制剂和气道重塑：早期、晚期和潜在的预防作用


尽管严重和/或致命性哮喘的气道重塑被认为是不可逆的，但其作为临床症状和/或肺功能变化原因的单个组成部分在很大程度上仍然未知。虽然吸入性糖皮质激素并未始终显示影响气道重塑，但针对气道炎症特定途径的生物制剂已被证明可以改善肺功能、粘液堵塞和气道结构变化，这可能超过糖皮质激素所见。生物治疗的这种优越性不能仅仅用糖皮质激素治疗的剂量不足或持续时间有限来解释，需要进一步探索。对于这一研究领域，我们提出了一种新的分类，将生物制剂对气道重塑的潜在影响分为三种时间效应：早期效应（数天至数周，主要调节炎症过程）、迟发效应（数月至数年，主要影响结构变化）和潜在预防作用（生物制剂早期治疗的结果）。为了确定生物制剂的潜在预防作用，我们呼吁研究探索早期生物治疗对中度至重度哮喘患者气道重塑的影响，这应伴随着对临床参数、生物标志物、治疗负担和社会经济影响的长期评估。