Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK.
Ann Med. 2012 Mar;44(2):146-56. doi: 10.3109/07853890.2011.585656. Epub 2011 Jun 17.
Asthma and chronic obstructive pulmonary disease (COPD) are chronic inflammatory disorders of the respiratory tract that are characterized by airflow limitation. They are distinct conditions with different causes, structural changes, and immunopathology. The pathophysiology in asthma and COPD involves not only the proximal large airways, but also the distal small airways, and thus the small airways are an important therapeutic target in the treatment of both diseases. The assessment of diseased distal small airways is challenging. Extensive disease can be present in the small airways with little abnormality in conventional pulmonary function tests. Recent advances in imaging technologies have led to better spatial resolution to assess small airways morphology non-invasively. New physiological tests have been developed to detect disease and response to therapy in regional airways. Improving the efficiency of existing aerosolized therapy to direct drug to the appropriate lung regions may improve clinical efficacy. Approaches to target distal lung regions include developing new drug formulations with smaller aerosol particle size or using inhaler devices that emit aerosolized drug at slow inhalation flows. Large studies are needed to determine whether better distal lung deposition leads to improvements in small airways function that are translated into clinically significant patient outcomes.
哮喘和慢性阻塞性肺疾病（COPD）是慢性呼吸道炎症性疾病，其特征是气流受限。它们是具有不同病因、结构变化和免疫病理学特征的不同疾病。哮喘和 COPD 的病理生理学不仅涉及近端大气道，还涉及远端小气道，因此小气道是治疗这两种疾病的重要治疗靶点。对病变远端小气道的评估具有挑战性。在常规肺功能检查中，小气道可能存在广泛病变，但无明显异常。成像技术的最新进展使得能够更好地评估小气道形态，而无需进行有创检查。已经开发出一些新的生理测试来检测气道的疾病和对治疗的反应。提高现有雾化治疗的效率，将药物靶向输送到适当的肺部区域，可能会提高临床疗效。靶向远端肺部区域的方法包括开发具有更小气溶胶颗粒大小的新药物制剂，或使用在缓慢吸气流量下释放雾化药物的吸入装置。需要进行大型研究来确定更好的远端肺沉积是否会导致小气道功能的改善，从而转化为具有临床意义的患者结局。
