Small airway dysfunction and bronchial asthma control : the state of the art

Abstract

According to national and international guidelines, achieving and maintaining asthma control is a major goal of disease management. In closely controlled clinical trials, good asthma control can be achieved , with the medical treatments currently available, in the majority of patients , but large population-based studies suggest that a significant proportion of patients in real-life setting experience suboptimal levels of asthma control and report lifestyle limitations with a considerable burden on quality of life. Poor treatment adherence and persistence, failure to use inhalers correctly, heterogeneity of asthma phenotypes and associated co-morbidities are the main contributing factors to poor disease control. Now, it is widely accepted that peripheral airway dysfunction , already present in patients with mild asthma, is a key contributor of worse control. The aim of this paper is to investigate the association between small-airways dysfunction and asthma symptoms/control. We therefore performed a PubMed search using keywords : small airways; asthma (limits applied: Humans, English language) and selected papers with a study population of asthmatic patients, reporting measurement of small-airways parameters and clinical symptoms/control.

The impact of the clinical pharmacist on the use of inhalers among asthmatic patients in Alkarak region in the South of Jordan

“…Studies worldwide showed that the prevalence of asthma control was not optimal in large per cent of asthmatic patients, per cent of poor controlled asthma were ranging from 44% to 57%, and there were a high percent of rescue medication usage . In Jordan, one study showed that 71% of asthmatic patients poorly controlled .…”

Omalizumab Rike in Therapy of Grave Therapeutically Resistent Allergic Asthma With Involvement of Small Respiratory Ways and Fixed Bronchial Obstruction. A Literature Review and Clinical Observation

“…Результаты представленных исследований позволяют сделать вывод о том, что ОМ разрывает «порочный круг» индукции и поддержания IgE-зависимого воспаления, существенно влияет на ремоделирование, в том числе и мелких ДП [4,8,[12][13][14]. Таким образом, на сегодняшний день имеются основания рассматривать ОМ в качестве лекарственного средства, модифицирующего болезнь.…”

“…В настоящее время имеются многочисленные доказа-тельства того, что частые дневные симптомы БА, повторяю-щиеся ночные эпизоды, плохой контроль, высокая БГР, увеличение числа обострений и потребности в системных кортикостероидах (СКС), развитие стероидозависимой БА ассоциированы с вовлечением мелких ДП [8]. Результаты трансбронхиальной биопсии демонстрируют, что мелкие ДП являются основным местом воспаления при тяжелой БА: инфильтрат состоит из эозинофилов, Т-лимфоцитов, нейтрофилов и макрофагов.…”

Nociceptin/Orphanin Fq in inflammation and remodeling of the small airways in experimental model of airway hyperresponsiveness

“…Human small airways consist of membranous, terminal, and respiratory bronchi of less than 2 mm diameter (Cottini et al 2015). In mice, small airways are defined as those having a diameter between 0 and 400 lm (Liu et al 2006;Sera et al 2007).…”

“…In mice, small airways are defined as those having a diameter between 0 and 400 lm (Liu et al 2006;Sera et al 2007). Several studies conducted over three decades ago demonstrated that the small airways are pathways of low resistance, contributing to less than 10% of the total resistance to airflow (Cottini et al 2015). For this reason, the small airways were originally described as the "quiet zone" of the lungs (Harrison et al 2008;Carr et al 2017).…”