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Treatment with inhaled corticosteroids probably decreased the rate of FEV1 decline, although this was more uncertain because of the lack of randomised double blind studies that show such an effect. Progress in the field of the genetics of asthma may, in the near future, elucidate the role of gene�Cenvironment interaction in lung function decline in asthma. Conclusion:? Regular treatment with inhaled corticosteroids may partly have a beneficial effect on airway remodelling in asthma. Improved understanding of the processes leading to airway remodelling is, however, important in order to prevent a large number of asthmatics from developing irreversible airflow obstruction. Please cite this paper as: Janson C. The importance of airway remodelling in the natural course of asthma. Ruxolitinib Clin Respir J 2010; 4 (Suppl. 1): 28�C34. Asthma is associated with airflow limitation and increased decline in lung function. The underlying mechanism for this impairment and decline is probably that persisting inflammation leads to remodelling of the airways. The purpose of this review is to investigate the importance of different factors that are related to airflow limitation and lung function decline in asthma. Asthma is defined as a disease characterised by airway inflammation, variable airflow obstruction, bronchial hyperresponsiveness Vemurafenib price (BHR) and airway symptoms such as wheeze and attacks of breathlessness (1). It has been showed in several investigations that asthma is associated with increased decline in lung function (2�C9). As an example, Peat et?al. found that the average rate of decline in forced expiratory volume in 1?s (FEV1) was 50?mL/year in non-smoking male asthmatics compared with 35?mL/year in non-smoking non-asthmatic men (2). The underlying Amiloride mechanism for the progressive lung function decline in asthma is probably that persisting inflammation leads to remodelling of airways with subepithelial fibrosis, smooth muscle hypertrophy and increased vascularisation (10�C12). The fact that most asthmatics have persistently increased bronchial responsiveness despite long-term anti-inflammatory treatment is also probably related to airway remodelling (13). A model for the relationship between symptoms, airflow obstructions, bronchial hyperresponsiveness and remodelling and asthma is presented in Fig.?1. The purpose of this review is to present data on the importance of different factors that are related to airflow limitation and lung function decline in asthma. The review begins with a case report of two patients as a way of demonstrating different aspects of airflow limitation in asthma. The two patients were found to have airflow limitation (FEV1/forced vital capacity?