Asthma is a disease of heterogeneous pathology, typically characterised by excessive inflammatory and bronchoconstrictor responses to the environment. The clinical expression of the disease is a consequence of the interaction between environmental factors and host factors over time, including genetic susceptibility, immune dysregulation and airway remodelling. As a critical interface between the host and the environment, the airway epithelium plays an important role in maintaining homeostasis in the face of environmental challenges. Disruption of epithelial integrity is a key factor contributing to multiple processes underlying asthma pathology. In this review, we first discuss the unmet need in asthma management and provide an overview of the structure and function of the airway epithelium. We then focus on key pathophysiological changes that occur in the airway epithelium, including epithelial barrier disruption, immune hyperreactivity, remodelling, mucus hypersecretion and mucus plugging, highlighting how these processes manifest clinically and how they might be targeted by current and novel therapeutics.

哮喘是一种具有异质性病理学的疾病，其典型特征是对环境的过度炎症和支气管收缩反应。该疾病的临床表现是环境因素和宿主因素随着时间的推移相互作用的结果，包括遗传易感性、免疫失调和气道重塑。作为宿主与环境之间的关键界面，气道上皮在面对环境挑战时维持体内平衡发挥着重要作用。上皮完整性的破坏是导致哮喘病理学多种过程的关键因素。在这篇综述中，我们首先讨论哮喘治疗中未满足的需求，并概述气道上皮的结构和功能。然后，我们重点关注气道上皮中发生的关键病理生理变化，包括上皮屏障破坏、免疫高反应性、重塑、粘液分泌过多和粘液堵塞，强调这些过程在临床上的表现以及当前和新型疗法如何针对它们。