Torrego Fernández Alfons, Muñoz Cano Rosa M
Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
Arch Bronconeumol. 2011 Apr;47 Suppl 2:17-9. doi: 10.1016/S0300-2896(11)70016-3.
Asthma continues to be a global health problem, despite advances in diagnostic techniques and treatment. The inflammatory nature of asthma is currently indisputable, as is the involvement of the entire respiratory tree, both the proximal and most distal airways, which has been demonstrated in multiple studies. The development of the therapeutic arsenal, with more potent drugs and improved inhalation devices, has allowed a certain control to be maintained over the inflammatory process, although the inability to reach the most distal points of the airways has posed a stumbling block that seems difficult to overcome. However, the available information on the real role of distal airway involvement in asthma remains very scarce. Physiopathological evidence shows that, in addition to the large airways, the small or distal airways (those with a diameter of less than 2 mm) substantially contribute to the severity of asthma. Several studies have shown that the inflammatory process seems to be more intense in this area. This finding has been related to nocturnal asthma and an increase in glucocorticoid receptor-beta-expressing cells, associated with corticosteroid-resistant asthma and fatal asthma. Equally, small airway involvement seems to be a highly important factor in asthma in the pediatric age group.
尽管在诊断技术和治疗方面取得了进展，但哮喘仍然是一个全球性的健康问题。哮喘的炎症本质目前是无可争议的，整个呼吸道树，包括近端和最远端气道的参与也是如此，这一点已在多项研究中得到证实。随着更有效的药物和改进的吸入装置等治疗手段的发展，尽管无法到达气道的最远端这一问题似乎难以克服，但已能够对炎症过程保持一定的控制。然而，关于远端气道参与哮喘的实际作用的现有信息仍然非常稀少。生理病理学证据表明，除了大气道外，小气道或远端气道（直径小于2毫米的气道）对哮喘的严重程度也有很大影响。多项研究表明，该区域的炎症过程似乎更为强烈。这一发现与夜间哮喘以及表达糖皮质激素受体-β的细胞增加有关，而这又与糖皮质激素抵抗性哮喘和致死性哮喘相关。同样，小气道受累似乎是儿童哮喘中一个非常重要的因素。
