Peripheral lung remodelling in asthma and chronic obstructive pulmonary disease

In this issue of the European Respiratory Journal , Vignola et al. 1 report an association between high-resolution computed tomography (HRCT) scan abnormalities of the conducting airways and an analysis of markers of the tissue remodelling process. They demonstrate an association between the level of HRCT abnormality in the airways and increased levels of active elastase with overproduction of tissue-inhibitor metalloproteinase-1 over metalloproteinase-9 in the sputum. The study design is cross-sectional in nature and based on small numbers of patients collected into three groups, according to whether they had newly diagnosed and untreated asthma, treated asthma or chronic obstructive pulmonary disease (COPD). The design does not include a control group with normal lung function and lacks longitudinal data collection to ensure that the sputum markers and HRCT abnormalities change in the expected directions with disease progression. After the first reading, the notion that editorial writers have been described as “the sort of people who come down from …