Department of Pulmonology, Semmelweis University, Budapest, Hungary.
J Asthma Allergy. 2013 Jun 6;6:69-80. doi: 10.2147/JAA.S25415. Print 2013.
Small airways disease plays an important role in the pathogenesis of asthma, but assessment of small airways impairment is not easy in everyday clinical practice. The small airways can be examined by several invasive and noninvasive methods, most of which can at present be used only in the experimental setting. Inhalers providing extrafine inhaled corticosteroid particle sizes may achieve sufficient deposition in the peripheral airways. Many studies have reported the beneficial effects of extrafine inhaled corticosteroids on inflammation, ie, on dysfunction in both the central and distal airways in asthmatics, and there are some data on asthma phenotypes in which the small airways seem to be affected more than in other phenotypes, including nocturnal asthma, severe steroid-dependent or difficult-to-treat asthma, asthma complicated by smoking, elderly asthmatic patients and/or patients with fixed airflow obstruction, and asthmatic children. The relevant randomized controlled clinical trials indicate that the efficacy of extrafine and nonextrafine inhaled corticosteroid formulations is similar in terms of primary endpoints, but there are certain clinically important endpoints for which the extrafine formulations show additional benefits.
小气道疾病在哮喘发病机制中起重要作用，但在日常临床实践中评估小气道损伤并不容易。可以通过几种有创和无创方法检查小气道，但目前大多数方法只能在实验环境中使用。提供超细吸入皮质类固醇粒径的吸入器可实现在外周气道中的充分沉积。许多研究报告了超细吸入皮质类固醇对炎症的有益作用，即对哮喘患者中央和远端气道功能障碍的有益作用，并且有一些关于小气道似乎比其他表型更受影响的哮喘表型的数据，包括夜间哮喘、严重依赖类固醇或难以治疗的哮喘、合并吸烟的哮喘、老年哮喘患者和/或有固定气流阻塞的哮喘患者以及哮喘儿童。相关的随机对照临床试验表明，超细和非超细吸入皮质类固醇制剂在主要终点方面的疗效相似，但对于某些具有临床重要意义的终点，超细制剂显示出额外的益处。
