Asthma and Allergy Research Group, Ninewells Hospital and Medical School, Dundee, Scotland.
Ann Allergy Asthma Immunol. 2013 Apr;110(4):233-9. doi: 10.1016/j.anai.2013.02.009.
To review the available methods of evaluating the small airways disease in asthma and the therapeutic strategies to achieve better control using emerging extrafine particle inhaler technologies.
The PubMed, MEDLINE (Ebsco), Scirus, Scopus, and Google Scholar databases were all scanned with Cross-search using the following keywords: asthma, small airways, hydrofluoroalkane 134a, extrafine particle, inhaled corticosteroid, long-acting β-agonist, spirometry, impulse oscillometry, nitrogen washout, exhaled nitric oxide, airway hyperresponsiveness, and adrenal suppression.
Key clinical studies considered to being relevant to the topic under review were evaluated.
There is an unmet need in current asthma guidelines for those individuals who exhibit the small airways asthma phenotype with a preserved forced expiratory volume in 1 second but abnormal forced midexpiratory flow and peripheral airway resistance, which tends to be associated with poorer control. Extrafine hydrofluoroalkane solution formulations of inhaled corticosteroid either alone or in combination with long-acting β-agonist may improve small airways outcomes and associated control.
From a pragmatic perspective, it makes sense to try to deliver asthma treatment to more of the lung to improve clinical outcomes, especially in patients who exhibit the small airways asthma phenotype.
综述评估哮喘小气道疾病的现有方法，以及利用新兴超细颗粒吸入器技术实现更好控制的治疗策略。
使用以下关键词在 PubMed、MEDLINE（Ebsco）、Scirus、Scopus 和 Google Scholar 数据库中进行了 Cross-search 扫描：哮喘、小气道、氢氟烷烃 134a、超细颗粒、吸入皮质类固醇、长效β激动剂、肺量计、脉冲振荡法、氮气冲洗、呼气一氧化氮、气道高反应性和肾上腺抑制。
评估了被认为与综述主题相关的关键临床研究。
目前的哮喘指南在那些表现出小气道哮喘表型的个体中存在未满足的需求，这些个体的第 1 秒用力呼气量正常但用力中期呼气流速和外周气道阻力异常，这往往与控制不佳相关。单独使用或联合长效β激动剂的吸入皮质类固醇的超细氢氟烷烃溶液制剂可能会改善小气道结局和相关控制。
从实用的角度来看，尝试将哮喘治疗输送到更多的肺部以改善临床结局是有意义的，特别是在表现出小气道哮喘表型的患者中。
