From the Guidelines
Goblet cell hypoplasia is not a feature of irreversible airway remodeling in patients with chronic asthma, instead, goblet cell hyperplasia is a characteristic finding. The pathophysiology of asthma, as described in the expert panel report 3 (epr-3): guidelines for the diagnosis and management of asthma-summary report 2007 1, highlights that asthma is a chronic inflammatory disorder of the airways, involving various cells and elements, including mast cells, eosinophils, neutrophils, T lymphocytes, macrophages, and epithelial cells. Key features of airway remodeling in chronic asthma include:
- Subepithelial fibrosis
- Increased smooth muscle mass
- Angiogenesis
- Goblet cell hyperplasia with increased mucus production These changes contribute to the persistence of symptoms and airflow limitation in patients with chronic asthma. The increase in goblet cells and subsequent mucus production is a critical component of airway remodeling, leading to airway obstruction and contributing to the symptoms of asthma, such as wheezing and shortness of breath, as supported by the guidelines 1. In the context of real-life clinical medicine, recognizing goblet cell hyperplasia as a feature of irreversible airway remodeling in chronic asthma is essential for understanding the disease's pathophysiology and for developing effective treatment strategies.
From the Research
Airway Remodeling in Asthma
- Airway remodeling is a pathological feature of chronic asthma that contributes to the clinical manifestations of the disease 2.
- Characteristic changes of airway remodeling in asthma include goblet cell hyperplasia, deposition of collagens in the basement membrane zone, increased size and number of microvessels in the submucosa, hyperplasia and hypertrophy of airway smooth muscle, and hypertrophy of submucosal glands 3.
Goblet Cell Abnormalities
- Goblet cell hyperplasia (GCH) has been established as a pathologic characteristic of mild, moderate, and severe asthma 4.
- Abnormalities in goblet cell number are accompanied by changes in stored and secreted mucin (MUC), with MUC5AC being the dominant MUC gene expressed in goblet cells 4.
- The process of working out the molecular mechanisms of GCH and goblet cell degranulation should provide new targets for novel therapeutic interventions 5.
Treatment Effects on Goblet Cell Metaplasia
- Corticosteroid treatment inhibits IL-13-induced goblet cell metaplasia of the airways in asthma, possibly through its effects on SPDEF and FOXa2 regulation of mucin gene expression 6.
- The addition of a long-acting β2-adrenergic receptor agonist (LABA) modestly augments the effects of corticosteroids on goblet cell metaplasia 6.
Relevance to Irreversible Airway Remodeling
- There is no direct evidence to suggest that goblet cell hypoplasia is a feature of irreversible airway remodeling in patients with chronic asthma.
- However, goblet cell hyperplasia is a characteristic feature of airway remodeling in asthma, and treatments that reduce goblet cell metaplasia may help to prevent or reverse airway remodeling 6, 3, 4, 5.