Therapeutic Perspectives in Vascular Remodeling in Asthma and Chronic Obstructive Pulmonary DiseaseAngiogenesis, Lymphangiogenesis and Clinical Implications

Abstract In chronic inflammatory airway diseases such as asthma and chronic obstructive pulmonary disease (COPD), changes in bronchial microvasculature are present and contribute to airway wall remodeling. Angiogenesis and vascular leak seem to be prevalent in asthma, while vasodilatation and vascular leak seem to be prevalent in COPD. The functional meaning of bronchial vascular remodeling is not completely known. The increase in vessel number and size as well as the vascular leakage may concur to the thickening of the airway wall and to the narrowing of the bronchial lumen. Accordingly, pharmacological control of bronchial vascular remodeling may be crucial for symptom control in asthma and COPD. In asthmatic airways, steroids can downregulate vascular remodeling by acting on proangiogenic factors, whereas long-acting β2-agonists seem to be mostly effective in decreasing vascular permeability. In COPD, there is less available experimental evidence on the effect of the currently used drugs on airway microvascularity changes. Importantly, vascular endothelial growth factor, the most specific grow factor for vascular endothelium, is crucially involved in the pathophysiology of the airway vascular remodeling, both in asthma and COPD. The inhibition of vascular endothelial growth factor and its receptors has the potential for the treatment of the vascular changes in the airway wall.