Date of Graduation

8-15-2009

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Annjanette Sommers MS, PA-C

Second Advisor

Rob Rosenow PharmD, OD

Abstract

INTRODUCTION: Asthma has been recognized as a disease with two main components: airway inflammation and airway remodeling. One particular aspect of airway remodeling, reticular basement membrane (RBM) thickening has been noted as a feature of asthmatic airways that could contribute to disease severity. The use of inhaled corticosteroids (ICS) has been observed to reduce inflammation in the airways of asthmatics, but its affects on specific components of airway remodeling are still in question.

METHODS: The focus of this study was to review the current literature for the last 10 years on all studies pertaining to RBM thickening in asthmatics and whether the use of ICS can reduce the RBM as determined by bronchial biopsy.

RESULTS: In the four studies reviewed, RBM thickening was noted in mild, moderate, or severe asthmatics as a group when compared to healthy controls. ICS use demonstrated a significant reduction in RBM thickness, when compared to asthmatic subjects who only used bronchodilators for symptom control. The greatest benefit to ICS use was noted when used at moderate to high dosages for periods longer than three months.

CONCLUSION: Long term, high dose ICS are effective at reducing RBM thickness in asthmatics. Although RBM thickening has been correlated with other signs of asthma severity such as airway hyperresponsiveness (AHR), further studies are needed to relate pathological changes to physiological measurements in asthma patients.

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