[Correspondence] Paradigm shifts in asthma: what is old is new again

An impressive review in The Lancet Respiratory Medicine by Celeste Porsbjerg and colleagues of recent publications on asthma1 updates the conceptual basis of underlying chronic pathophysiology. At last, the focus might shift from a monoculture based on immunity and inflammation to a more balanced paradigm including other, albeit interactive, non-immune but equally core aspects. Such aspects might include epithelial activation, with epithelial–mesenchymal transition, subepithelial myofibroblast hyperplasia, and fibrosis, and the different components of airway wall thickening.