The role of small airway disease in asthma

Abstract

Small airway inflammation is present in all stages of asthmatic disease and plays an important role in many key clinical conditions/phenotypes. In order to control the disease, we need to target small airway inflammation, which is not only difficult to reach by standard inhaled medications but also to some extent different. A better understanding of the important role small airways are playing in asthma will show that the 'silent zone' is by far not silent at all.

ERS/EAACI statement on severe exacerbations in asthma in adults: facts, priorities and key research questions

“…For this purpose, multiple initiatives have investigated and weighed the importance of individual traits in predicting recurrent exacerbations. Many other characteristics and conditions have also been reported, such as amount of asthma medication, comorbidities including obesity, occupational stress [31], sensitisation, indoor and outdoor pollution, small airway dysfunction [32], loss of lung elastic recoil [33], and psychological factors [29,[34][35][36][37][38][39][40][41][42][43][44]. Retrospective studies have shown that repeated assessment of composite scores of control, such as the Asthma Control Test or Asthma Control Questionnaire, and other tools, such as eHealth and mHealth [45], may predict severe exacerbations [46].…”

Study on small airway function in asthmatics with fractional exhaled nitric oxide and impulse oscillometry

“…11,12 However, traditional spirometry requires participators to perform forced expiratory maneuvers, which is difficult for young children and old subjects and hampers reproducibility. 13 The invasive techniques such as surgical resection, transbronchial biopsy, and optical coherence tomography(OCT) 14 can be direct and objective to assess small airway function, but they have significant risks and inconveniences for patients and cannot be repeated often. 15 Some sophisticated techniques such as fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) may surmount such restrictions.…”

Current Administration of Antileukotrienes in Adults With Asthma

“…Однако суммарный объем и поверхность мелких ДП намного больше, чем крупных и средних, поэтому изменения, происходящие в дистальных ДП и парен-химе легких, оказывают значимое влияние на течение БА. Неконтролируемое воспаление мелких ДП приво-дит к их ремоделированию и прогрессированию забо-левания, поэтому воздействие на периферическое воспаление необходимо для достижения оптимально-го контроля над БА [13]. Воспаление мелких ДП име-ет большое значение для таких фенотипов заболева-ния, как АФУ, ночная БА, трудноконтролируемая БА, БА с высоким риском повторных обострений.…”