Small airway dysfunction and poor asthma control: a dangerous liaison

Cottini, Marcello; Licini, Anita; Lombardi, Carlo; Bagnasco, Diego; Comberiati, Pasquale; Berti, Alvise

doi:10.1186/s12948-021-00147-8

Cited by 37 publications

(30 citation statements)

References 117 publications

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“…These data highlight a significant effect of mepolizumab on airflow limitation in the peripheral airways. Indeed, in real-world settings, FEF25-75 is considered to be the most commonly used spirometric indicator of small airway patency in real-life clinical practice [ 28 ]. Within the context of the Severe Asthma Research Program (SARP) project, it was observed that some severe asthmatic patients who had a more severe reduction of FEF25-75 also displayed more symptoms and a greater need for medication, as well as higher FeNO levels, total serum IgE concentrations, and bronchial hyperresponsiveness [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Real-Life Effectiveness of Mepolizumab on Forced Expiratory Flow between 25% and 75% of Forced Vital Capacity in Patients with Severe Eosinophilic Asthma

et al. 2021

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Severe eosinophilic asthma (SEA) is associated with high peripheral blood and airway eosinophilia, recurrent disease exacerbations and severe airflow limitation. Eosinophilic inflammation is also responsible for small airway disease (SAD) development. SEA patients experience poor disease control and response to standard therapy and are prime candidates for anti-IL5 biologicals, such as mepolizumab, but the effect of treatment on SAD is unclear. We investigated the effect of mepolizumab on lung function in SEA patients, focusing on SAD parameters, and searched for an association between patients’ phenotypic characteristics and changes in small airways function. In this real-life study, data from 105 patients with SEA were collected at baseline and after 6, 12 and 18 months of mepolizumab treatment. Along with expected improvements in clinical and lung function parameters brought by Mepolizumab treatment, FEF2525-75% values showed a highly significant, gradual and persistent increase (from 32.7 ± 18.2% at baseline to 48.6 ± 18.4% after 18 months) and correlated with ACT scores at 18 months (r = 0.566; p ≤ 0.0001). A patient subgroup analysis showed that changes in FEF25-75% values were higher in patients with a baseline peripheral blood eosinophil count ≥400 cells/μL and oral corticosteroid use. Mepolizumab significantly improves small airway function. This effect correlates with clinical benefits and may represent an accessible parameter through which to evaluate therapeutic response. This study provides novel insights into the phenotypic characteristics associated with the improved functional outcome provided by mepolizumab treatment.

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Section: Discussionmentioning

confidence: 99%

Real-Life Effectiveness of Mepolizumab on Forced Expiratory Flow between 25% and 75% of Forced Vital Capacity in Patients with Severe Eosinophilic Asthma

et al. 2021

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“…SAD was previously linked to some clinical phenotypes of patients, i.e., active smokers, elderly patients with long duration of asthma and presence of fixed airflow obstruction, patients with nocturnal and exercise-induced symptoms, severe/uncontrolled asthma ( 13 – 16 ). The limit of most of the available studies is that they analyze the association of single features with SAD, instead ofcomprehensively address multiple asthma features associated with SAD.…”

Section: Association Of Sad With Specific Asthma Phenotypes and Poor ...mentioning

confidence: 99%

“…We previously reviewed the prevalence and negative impact of SAD on asthma control, without addressing the position of current international guidelines on the role of SAD in asthma ( 13 ). In recent years, several original studies and systematic reviews confirmed that SAD is associated with, among others, greater bronchial hyper-responsiveness, worse asthma control and severity, more nocturnal and exercise-induced symptoms, and a higher number of exacerbations ( 14 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

Small Airways: The “Silent Zone” of 2021 GINA Report?

Cottini¹,

Lombardi

Passalacqua

et al. 2022

Front. Med.

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Asthma is a chronic disease, affecting approximately 350 million people worldwide. Inflammation and remodeling in asthma involve the large airways, and it is now widely accepted that the small airways (those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and are the major determinant of airflow obstruction in this disease. From a clinical perspective, small airways dysfunction (SAD) is associated with more severe bronchial hyperresponsiveness, worse asthma control and more exacerbations. Unlike the GOLD guidelines which, in their definition, identify COPD as a disease of the small airways, the Global Initiative for Asthma (GINA) guidelines do not refer to the prevalence and role of SAD in asthmatic patients. This decision seems surprising, given the growing body of compelling evidence accumulating pointing out the high prevalence of SAD in asthmatic patients and the importance of SAD in poor asthma control. Furthermore, and remarkably, SAD appears to possess the characteristics of a treatable pulmonary trait, making it certainly appealing for asthma control optimization and exacerbation rate reduction. In this mini-review article, we address the most recent evidence on the role of SAD on asthma control and critically review the possible inclusion of SAD among treatable pulmonary traits in international guidelines on asthma.

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“…IOS is not a new technology ( 76 ), but more recent portable units facilitate its use beyond the pulmonary function laboratory, including field studies of the workplace. IOS measures the mechanical properties of the respiratory system including upper and intrathoracic airways, lung tissue and chest wall, specifically respiratory impedance, and is thought to be sensitive for dysfunction of the small airways ( 77 , 78 ). Histopathological changes in small airways of workers exposed to alpha-diketones are characterized by bronchiolar wall fibrosis, leading to luminal narrowing and obliteration that obstructs airflow ( 79 ).…”

Section: Methods and Discussionmentioning

confidence: 99%

“…IOS measures the mechanical properties of the respiratory system including upper and intrathoracic airways, lung tissue and chest wall, specifically Are you ever within an arm's length of these locations/units? Coffee roaster, cooling bins of roasted coffee, grinder, hoppers or containers of roasted coffee, coffee being packaged, packaged coffee, flavoring is being added or mixed respiratory impedance, and is thought to be sensitive for dysfunction of the small airways (77,78). Histopathological changes in small airways of workers exposed to alpha-diketones are characterized by bronchiolar wall fibrosis, leading to luminal narrowing and obliteration that obstructs airflow (79).…”

Section: Health Assessment Strategymentioning

confidence: 99%

A Strategy for Field Evaluations of Exposures and Respiratory Health of Workers at Small- to Medium-Sized Coffee Facilities

Virji

Cummings

Cox‐Ganser

2021

Front. Public Health

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Coffee production is a global industry with roasteries throughout the world. Workers in this industry are exposed to complex mixtures of gases, dusts, and vapors including carbon monoxide, carbon dioxide, coffee dust, allergens, alpha-diketones, and other volatile organic compounds (VOCs). Adverse respiratory health outcomes such as respiratory symptoms, reduced pulmonary function, asthma, and obliterative bronchiolitis can occur among exposed workers. In response to health hazard evaluations requests received from 17 small- to medium-sized coffee facilities across the United States, the National Institute for Occupational Safety and Health conducted investigations during 2016–2017 to understand the burden of respiratory abnormalities, exposure characteristics, relationships between exposures and respiratory effects, and opportunities for exposure mitigation. Full-shift, task-based, and instantaneous personal and area air samples for diacetyl, 2,3-pentanedione and other VOCs were collected, and engineering controls were evaluated. Medical evaluations included questionnaire, spirometry, impulse oscillometry, and fractional exhaled nitric oxide. Exposure and health assessments were conducted using standardized tools and approaches, which enabled pooling data for aggregate analysis. The pooled data provided a larger population to better address the requestors' concern of the effect of exposure to alpha-diketones on the respiratory heath of coffee workers. This paper describes the rationale for the exposure and health assessment strategy, the approach used to achieve the study objectives, and its advantages and limitations.

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Small airway dysfunction and poor asthma control: a dangerous liaison

Cited by 37 publications

References 117 publications

Real-Life Effectiveness of Mepolizumab on Forced Expiratory Flow between 25% and 75% of Forced Vital Capacity in Patients with Severe Eosinophilic Asthma

Real-Life Effectiveness of Mepolizumab on Forced Expiratory Flow between 25% and 75% of Forced Vital Capacity in Patients with Severe Eosinophilic Asthma

Small Airways: The “Silent Zone” of 2021 GINA Report?

A Strategy for Field Evaluations of Exposures and Respiratory Health of Workers at Small- to Medium-Sized Coffee Facilities

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