Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review

Wiel, Erica van der; Hacken, Nick H. T. ten; Postma, Dirkje S.; Berge, Maarten van den

doi:10.1016/j.jaci.2012.12.1567

Cited by 161 publications

(116 citation statements)

References 116 publications

(138 reference statements)

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“…Wheezing during resting expiration is considered to be a more severe symptom than that during forced expiration [16]; thus, if the patient is found to have wheezing in a clinical interview, which is assumed that asthma is inadequately controlled, the treatment strategy would be re-evaluated. The respiratory reactance indicators Fres and AX are considered to primarily reflect the elastic properties of the respiratory system [17], and are associated with small-airway dysfunction in asthma [18]; however, the clinical significance Open Journal of Respiratory Diseases of Fres and AX remains unclear. Both Fres and AX were high, not only in the groups with inadequately controlled asthma, but also in the high-score groups for limitation of normal daily activities and shortness of breath, which are exercise-induced symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Both Fres and AX were high, not only in the groups with inadequately controlled asthma, but also in the high-score groups for limitation of normal daily activities and shortness of breath, which are exercise-induced symptoms. In addition to nocturnal asthma and ACQ score, exercise-induced asthma may be associated with small-airway dysfunction, which is related to exacerbation risk [18] [19]. Despite the importance of improving small airway dysfunction, it is difficult to assess in a primary care setting.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of Asthma Symptoms to Assess Asthma Control Status in a Primary Care Setting: An Exploratory Analysis of Pooled Data from Three Trials

Hozawa¹,

Terada²,

Hozawa³

2018

OJRD

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Background: Primary care physicians in Japan see many patients in a given day; consequently, they find it challenging to devote sufficient time for detailed clinical consultation and evaluation of asthma control status. The aim of this study was to investigate asthma symptoms that reveal the presence of inadequately controlled asthma. Methods: A pooled analysis of baseline data from 100 patients with asthma treated with inhaled corticosteroid(s) (ICS) alone or ICS/long-acting beta-agonist who participated in three previous clinical trials was performed. Asthma control status and asthmatic symptoms were determined using a five-item Asthma Control Questionnaire, and whether asthmatic symptoms reflect clinical markers was investigated. Results: Nocturnal awakening owing to asthmatic symptoms was observed only in the uncontrolled asthma group. Patient-reported wheezing was not observed in the group with well-controlled asthma, but was observed in all patients in the uncontrolled asthma group. Virtually all patients, irrespective of asthma control status, reported symptoms in the morning, limitation of normal daily activities, and shortness of breath. Conclusions: The presence of nocturnal awakening due to asthma and wheezing likely reflected uncontrolled asthma. These results will lead to re-recognition that clinical interview, querying nocturnal awakening from asthma and wheezing is a simple and useful approach to assess asthma control status in a primary care setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Asthma Symptoms to Assess Asthma Control Status in a Primary Care Setting: An Exploratory Analysis of Pooled Data from Three Trials

Hozawa¹,

Terada²,

Hozawa³

2018

OJRD

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“…Small airways include all peripheral membranous bronchioles <2 mm in diameter, whereas large airways contain smooth muscle and cartilage and have a luminal diameter >2 mm (bronchi up to terminal bronchioles) [7]. Numerous reviews on the importance of small airways in asthma and other airway diseases have been published in recent years, including the following [8][9][10][11][12].…”

Section: Different Lung Compartments Involved In Asthma(s)mentioning

confidence: 99%

Should lung biopsies be performed in patients with severe asthma?

2015

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Asthma, and severe asthma, in particular, is increasingly recognised as a heterogeneous disease. Identifying these different phenotypes of asthma and assigning patients to phenotype-specific treatments is one of the current conundrums in respiratory medicine. Any diagnostic procedure in severe asthma (or any disease) should have two aims: 1) better understanding or identifying the diagnosis, and 2) providing information on the heterogeneity of asthma phenotypes to guide therapy with the objective of improving outcomes. Lung biopsies can target the large and small airways as well as the lung parenchyma. All compartments are affected in severe asthma; however, knowledge on the distal lung is limited. At this point, it remains uncertain whether lung specimens routinely add diagnostic information that is unable to be obtained otherwise. Indeed, whether a lung biopsy is indicated in the workup of a patient with severe asthma remains an individual decision. It is hoped this review will support rational decision-making and provide a detailed synopsis of the varied histopathological features seen in biopsies of patients with a diagnosis of severe asthma. Due to limited data on this topic this review is primarily based on opinion with recommendations arising primarily from the personal experience of the authors.

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“…Asthma is an inflammatory airway disorder that involves also the small airways (defined as the peripheral membranous bronchioles <2 mm in diameter) (3). Two decades ago, Wagner et al (4) demonstrated a more than sevenfold increase in small airway resistance in asymptomatic asthma with normal spirometry (FEV 1 and forced vital capacity (FVC)).…”

mentioning

confidence: 99%

Airway hyper-responsiveness and small airway function in children with well-controlled asthma

Huang

Zhang

et al. 2015

Pediatr Res

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Background: Airway hyper-responsiveness (AHR) and small airway function are critical to children with asthma. Little is known about the role of the small airway in well-controlled subjects with AHR. We aimed to evaluate AHR and small airway function in children with well-controlled asthma, and to investigate the association between them. Methods: We studied 116 cases of children with well-controlled asthma (group A), 46 cases healthy children as controls (group C). Spirometry, impulse oscillometry (IOS), and methacholine challenge test (MCT) were conducted on all the children. results: (i) Group A and group C had no differences in forced expiratory volume in 1 s (FEV 1 ) and FEV 1 /forced vital capacity (FVC) ratio (P > 0.05). Forced expiratory flow between 25 and 75% of vital capacity ) and reactance at 5 Hz (X5) in group A were significantly lower than those in group C. (ii) One hundred and five cases (90.5%) of group A proved positive to MCT. (iii) FEF in group A proved positive to MCT but were lower than those proved negative (P < 0.05). conclusion: AHR persisted in majority of children with well-controlled asthma. Among children with well-controlled asthma, small airway function was lower in those with AHR than those without AHR. a sthma is the most common chronic lower respiratory disease in childhood throughout the world. The newest Global Initiative for Asthma guidelines, as well as international consensus on pediatric asthma suggested that, after initial severity assessment, ongoing care should include continual assessment of the patient's asthma control in terms of real-life activities (1,2). This approach uses a cycle of detailed assessment and intervention to achieve and maintain asthma control. The level of control is defined by frequency of asthma symptoms, and the degree of lung function (forced expiratory volume in 1 s (FEV 1 ), peak expiratory flow). But in some cases called "well controlled asthma" with no disease activity and normal lung function, how can we evaluate and manage them? Airway hyper-responsiveness (AHR) is a clinical feature of asthma and is often in proportion to the underlying severity of the disease. AHR of children with well-controlled asthma can display condition of the disease. But, the evaluation of AHR is not popular in pediatric clinic. In areas without this means, how can we do next?Asthma is an inflammatory airway disorder that involves also the small airways (defined as the peripheral membranous bronchioles <2 mm in diameter) (3). Two decades ago, Wagner et al. (4) demonstrated a more than sevenfold increase in small airway resistance in asymptomatic asthma with normal spirometry (FEV 1 and forced vital capacity (FVC)). The contribution of the small airways to the development of the clinical features and functional impairment in asthma is incompletely understood (5). Study suggested that asthmatics with AHR have more severe small airways obstruction, but little is known about the role of the small airways in asymptomatic subjects with AHR. Therefore, the aim of our...

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Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review

Cited by 161 publications

References 116 publications

Evaluation of Asthma Symptoms to Assess Asthma Control Status in a Primary Care Setting: An Exploratory Analysis of Pooled Data from Three Trials

Evaluation of Asthma Symptoms to Assess Asthma Control Status in a Primary Care Setting: An Exploratory Analysis of Pooled Data from Three Trials

Should lung biopsies be performed in patients with severe asthma?

Airway hyper-responsiveness and small airway function in children with well-controlled asthma

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