The way forward in asthma: integrative physiology

In the process of searching for the pathogenesis and effective treatment of asthma, it has increasingly been realized that the key processes occur at the cellular and molecular levels. Recognition of this principle and the appropriate tools have led to explosive developments in the description of the fundamental abnormalities in the disease and discovery of potential targets for therapeutic intervention. However, remarkably, the link between these cellular processes and the phenotypic expression of asthma has been more difficult to understand. How does inflammation cause variable airways obstruction and the perceived dyspnea? Very recent research, including the combined use of pathology, imaging techniques, and in vivo and in vitro physiological experiments, has renewed interest in the integrative airway pathophysiology in asthma. This research has provided new knowledge on the mechanisms determining the essential abnormalities in the patients with this disease, namely excessive airway narrowing and impaired bronchodilation following a deep breath. It is postulated that inclusion of such physiological abnormalities in new and long term therapeutic strategies will lead to a better clinical as well as histological outcome of asthma