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International Journal of Endocrinology
Volume 2012, Article ID 397693, 6 pages
Review Article

Role of Inhaled Steroids in Vascular Airway Remodelling in Asthma and COPD

Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Padiglione Rasori, Azienda Ospedaliero-Universitaria, Viale Rasori 10, 43125 Parma, Italy

Received 11 July 2012; Revised 5 September 2012; Accepted 10 September 2012

Academic Editor: Andrew Chan

Copyright © 2012 Alfredo Chetta and Dario Olivieri. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In chronic obstructive airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD), changes in bronchial microvasculature are present in response to inflammatory stimuli. Vascular changes may significantly contribute to airway wall remodelling. Angiogenesis and vascular leakage are prevalent in asthma, while vasodilation and vascular leakage dominate in COPD. An endothelial dysfunction may be present both in asthma and in COPD. Vascular changes may occur simultaneously with the thickening of the airway wall and the narrowing of the bronchial lumen. Consequently, pharmacological control of bronchial vascular remodelling may be crucial for symptom control in asthma and COPD. In asthmatic airways, inhaled steroids can downregulate vascular remodelling by acting on proangiogenic factors. Additionally, studies on combination therapy with long-acting β2-agonists and inhaled steroids have provided evidence of a possible synergistic action on components of vascular remodelling in asthma. In COPD, there is less experimental evidence on the effect of inhaled steroids on airway microvascular changes. Importantly, vascular endothelial growth factor (VEGF), the most specific growth factor for vascular endothelium, is crucially involved in the pathophysiology of airway vascular remodelling, both in asthma and COPD. The inhibition of VEGF and its receptor may be useful in the treatment of the vascular changes in the airway wall.