The Relevance of Targeting Treatment to Small Airways in Asthma and COPD

被引:41
作者
Santus, Pierachille [1 ,2 ]
Radovanovic, Dejan [1 ,2 ]
Pecchiari, Matteo [3 ]
Ferrando, Matteo [4 ]
Tursi, Francesco [5 ]
Patella, Vincenzo [6 ]
Braido, Fulvio [4 ]
机构
[1] Univ Milan, Dept Biomed & Clin Sci DIBIC, Milan, Italy
[2] Osped L Sacco, ASST Fatebenefratelli Sacco, Div Resp Dis, Milan, Italy
[3] Univ Milan, Dept Clin & Surg Pathophysiol & Transplantat, Milan, Italy
[4] Univ Genoa, Dept Internal Med, Azienda Policlin IRCCs San Martino, Resp Dis & Allergy Clin, Genoa, Italy
[5] Osped Codogno, USS Serv Pneumol, USC Pneumol, Dipartimento Med,Azienda Socio Sanit Terr Lodi, Lodi, Italy
[6] Battipaglia Hosp, Dept Med Sci, Allergol & Clin Immunol Unit, Salerno, Italy
关键词
small airways; COPD; asthma; severe asthma; small particles; ventilation inhomogeneity; closing volume; OBSTRUCTIVE PULMONARY-DISEASE; EXHALED NITRIC-OXIDE; AIR-FLOW OBSTRUCTION; HE-3; MAGNETIC-RESONANCE; PRESSURE-VOLUME CURVES; REGIONAL LUNG-FUNCTION; BREATH N-2 TEST; CLOSING VOLUME; VENTILATION DISTRIBUTION; BECLOMETHASONE DIPROPIONATE;
D O I
10.4187/respcare.07237
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
COPD and asthma have different risk factors and pathogenesis, but they share a pathophysiologic hallmark characterized by small airways disease. Although difficult to explore and measure, modifications of distal airways' pathophysiology and biology represent an early sign of obstructive disease and should be researched and assessed in everyday clinical practice. In the last 15 years, computed microtomography scans have shed light on the anatomy and physiology of the so-called silent zone, and research devoted to investigate the effect of inhaled treatments on small airway pathophysiology has been increasing. This narrative review offers a historical summary of researchers and landmark studies that reported, defined, and advanced the research on small airways. We then discuss the latest findings on the role and characteristics of the small airways' inflammatory and cellular structure, and we describe the assessment tools available to detect small airways dysfunction in COPD and asthma and the effect of bronchodilators and inhaled steroids on functional and biological biomarkers. Finally, we analyze the newest technological therapeutic advances aimed at small airways treatment in terms of inhalation devices and small particle size molecules.
引用
收藏
页码:1392 / 1412
页数:21
相关论文
共 201 条
[1]   A Spectroscopic Approach to Investigate the Molecular Interactions between the Newly Approved Irreversible ErbB blocker "Afatinib" and Bovine Serum Albumin [J].
Alanazi, Amer M. ;
Abdelhameed, Ali Saber .
PLOS ONE, 2016, 11 (01)
[2]   Persistently elevated exhaled nitric oxide fraction is associated with increased risk of exacerbation in COPD [J].
Alcazar-Navarrete, Bernardino ;
Ruiz Rodriguez, Oliverio ;
Conde Baena, Pablo ;
Romero Palacios, Pedro Jose ;
Agusti, Alvar .
EUROPEAN RESPIRATORY JOURNAL, 2018, 51 (01)
[3]   Real-life prospective study on asthma control in Italy: Cross-sectional phase results [J].
Allegra, Luigi ;
Cremonesi, Giovanni ;
Girbino, Giuseppe ;
Ingrassia, Eleonora ;
Marsico, Serafino ;
Nicolini, Gabriele ;
Terzano, Claudio .
RESPIRATORY MEDICINE, 2012, 106 (02) :205-214
[4]  
ANDERSEN LH, 1980, CLIN RES PROC, V16, P215
[5]  
ANTHONISEN NR, 1968, CLIN SCI, V35, P495
[6]  
ANTIC R, 1976, AM REV RESPIR DIS, V114, P851
[7]   Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease [J].
Bajc, M. ;
Chen, Y. ;
Wang, J. ;
Li, X. Y. ;
Shen, W. M. ;
Wang, C. Z. ;
Huang, H. ;
Lindqvist, A. ;
He, X. Y. .
INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, 2017, 12 :1579-1587
[8]   Immunology of asthma and chronic obstructive pulmonary disease [J].
Barnes, Peter J. .
NATURE REVIEWS IMMUNOLOGY, 2008, 8 (03) :183-192
[9]   Cellular and molecular mechanisms of asthma and COPD [J].
Barnes, Peter J. .
CLINICAL SCIENCE, 2017, 131 (13) :1541-1558
[10]   Inflammatory mechanisms in patients with chronic obstructive pulmonary disease [J].
Barnes, Peter J. .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2016, 138 (01) :16-27