Small airways in asthma:Pathophysiology,identification and management  

作　　者：Dimitrios Toumpanakis Omar S.Usmani 

机构地区：[1]National Heart and Lung Institute,Imperial College London,London,SW36LY,United Kingdom [2]General State Hospital for Thoracic Diseases of Athens“Sotiria”,Athens,11527,Greece

出　　处：《Chinese Medical Journal Pulmonary and Critical Care Medicine》2023年第3期171-180,共10页呼吸与危重症医学（英文）

基　　金：DT is a recipient of a Long-Term Research Fellowship from the Eu-ropean Respiratory Society.

摘　　要：Background:The aim of this review is to summarize the current evidence regarding small airway disease in asthma,focusing on recent advances in small airway pathophysiology,assessment and therapeutic implications.Methods:A search in Medline was performed,using the keywords“small airways”,“asthma”,“oscillometry”,“nitrogen washout”and“imaging”.Our review was based on studies from adult asthmatic patients,although evidence from pediatric populations is also discussed.Results:In asthma,inflammation in small airways,increased mucus production and airway wall remodelling are the main pathogenetic mechanisms of small airway disease.Small airway dysfunction is a key component of asthma pathophysiology,leading to increased small airway resistance and airway closure,with subsequent ventilation inhomogeneities,hyperresponsiveness and airflow limitation.Classic tests of lung function,such as spirometry and body plethysmography are insensitive to detect small airway disease,providing only indirect measurements.As discussed in our review,both functional and imaging techniques that are more specific for small airways,such as oscillometry and the multiple breath nitrogen washout have delineated the role of small airways in asthma.Small airways disease is prevalent across all asthma disease stages and especially in severe disease,correlating with important clinical outcomes,such as asthma control and exacerbation frequency.Moreover,markers of small airways dysfunction have been used to guide asthma treatment and monitor response to therapy.Conclusions:Assessment of small airway disease provides unique information for asthma diagnosis and monitor-ing,with potential therapeutic implications.

关 键 词：Small airways ASTHMA OSCILLOMETRY Nitrogen washout 

分 类 号：R562.25[医药卫生—呼吸系统]