Last updated on 04/03/2025

WHAT IS AIRWAY REMODELLING?

When people with asthma have a flare-up, it is more difficult to breathe because of the narrowing of the airways. This narrowing can occur because of contraction of the muscle around the air tubes, inflammation in the airway wall, or both of these processes.  

It is important to realise that after an episode of wheeziness the lung often don’t quite go back to normal. Over time damage accumulates and changes the structure of the airways: this is Airway Remodelling.   

People with asthma are often not aware of these changes in their lungs until they are quite advanced and begin to affect everyday activities. 

WHAT CHANGES OCCUR?

  • Thickening of airway walls: The muscles around the airways get bigger and thicker the more they contract. Inflammation also thickens the airway lining over time. This tends to result in permanent narrowing of the airways, making breathing increasingly difficult over many years. 
  • Damaged airway lining: the lining of the airway which normally acts as a protective barrier and a crucial part of your immune defence becomes damaged from inflammation. The hairlike structures that help remove debris from the airways are also damaged. 
  • Increased mucous production: gland enlargement in the airway walls causes excess mucous production, which can no longer be cleared as effectively. This contributes to airway blockage.   

These changes lead to reduced lung function, more frequent infections and more frequent asthma flare-ups.  

The risk of airway remodelling increases with:  

  • Frequency of flare ups   
  • Severity of flare ups   
  • Duration of asthma in years  
  • Smoking and other noxious exposures  

People who have one severe asthma attack (that needs emergency care) each year lose about as much function as someone who is a regular smoker. 

WHAT HAPPENS DURING AN ASTHMA ATTACK?

WHY IS GOOD ASTHMA CONTROL IMPORTANT?

Maintaining good asthma control with daily self-management will help reduce the risk of airway remodelling by: 

  • Reducing airway inflammation 
  • Reducing airway muscle tightening  
  • Protecting lung function  
  • Preventing flare-ups 

KEY TIPS FOR MANAGING ASTHMA AND REDUCING RISK OF AIRWAY REMODELLING:

  • Take preventer medicine as prescribed to reduce inflammation and asthma symptoms. 
  • Avoid exposure to triggers such as infections, allergens and irritants where possible.  
  • Make sure your vaccinations are up to date to reduce the impact of respiratory infections. 
  • Schedule regular reviews with your healthcare provider to check your lung function and treatment plan.  
  • Avoid smoking or vaping, as both irritate the airways and increases the risk of airway remodelling. 

References 

  • AbuJabal, R. et al. (2024) ‘Role of IL-5 in asthma and airway remodelling’, Clinical and Experimental Allergy, 54(8). 
  • Grainge, C.L. et al. (2011) ‘Effect of Bronchoconstriction on Airway Remodeling in Asthma’, The New England Journal of Medicine, 364(20), pp. 2006-2015. doi: 10.1056/NEJMoa1014350. Available at: https://www.nejm.org/doi/full/10.1056/NEJMoa1014350