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Biologics and Airway Remodeling in Severe Asthma
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  • Gilda Varricchi,
  • Sebastian Ferri,
  • Jack Pepys,
  • Remo Poto,
  • Giuseppe Spadaro,
  • Nappi Emanuele,
  • Giovanni Paoletti,
  • Christian Virchow,
  • Enrico Heffler,
  • Giorgio Walter Canonica
Gilda Varricchi
Universita degli Studi di Napoli Federico II Dipartimento di Scienze Mediche Traslazionali

Corresponding Author:gildanet@gmail.com

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Sebastian Ferri
Humanitas University
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Jack Pepys
Humanitas University
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Remo Poto
Universita degli Studi di Napoli Federico II Dipartimento di Scienze Mediche Traslazionali
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Giuseppe Spadaro
Universita degli Studi di Napoli Federico II Dipartimento di Scienze Mediche Traslazionali
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Nappi Emanuele
Humanitas University
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Giovanni Paoletti
Humanitas University
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Christian Virchow
Universitatsmedizin Rostock Abteilung Pneumologie und Interdisziplinare Internistische Intensivmedizin
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Enrico Heffler
Humanitas University
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Giorgio Walter Canonica
Humanitas University
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Abstract

Asthma is a chronic inflammatory airway disease resulting in airflow obstruction, which in part can become irreversible to conventional therapies, defining the concept of airway remodeling. The introduction of biologics in severe asthma has led in some patients to the complete normalization of previously considered irreversible airflow obstruction. This highlights the need to distinguish a “fixed” bronchial obstruction due to structural changes unresponsive to current therapies, from a “reversible” one as demonstrated by lung function normalization during biological therapies not previously obtained even with high dose systemic glucocorticoids. The mechanisms by which exposure to environmental factors initiates the inflammatory responses that trigger airway remodeling are still incompletely understood. Alarmins represent tissue-derived cytokines that initiate immunologic events leading to inflammatory airway remodeling. Biological therapies can improve airflow obstruction by addressing these airway inflammatory changes. In addition, biologics might prevent and possibly even revert “fixed” remodeling due to structural changes. Hence, it appears clinically important to separate the therapeutic effects (early and late) of biologics as a new paradigm to evaluate the effects of these drugs and future treatments on airway remodeling in severe asthma.
25 Apr 2022Submitted to Allergy
25 Apr 2022Submission Checks Completed
25 Apr 2022Assigned to Editor
01 May 2022Reviewer(s) Assigned
21 May 2022Review(s) Completed, Editorial Evaluation Pending
25 May 2022Editorial Decision: Revise Minor
23 Jun 20221st Revision Received
24 Jun 2022Submission Checks Completed
24 Jun 2022Assigned to Editor
25 Jun 2022Reviewer(s) Assigned
27 Jun 2022Review(s) Completed, Editorial Evaluation Pending
11 Jul 2022Editorial Decision: Revise Minor
03 Aug 20222nd Revision Received
04 Aug 2022Submission Checks Completed
04 Aug 2022Assigned to Editor
05 Aug 2022Editorial Decision: Accept
23 Aug 2022Published in Allergy. 10.1111/all.15473