Braido F, Scichilone N, Lavorini F, Usmani O S, Dubuske L, Boulet L P, Mosges R, Nunes C, Sánchez-Borges M, Ansotegui I J, Ebisawa M, Levi-Schaffer F, Rosenwasser L J, Bousquet J, Zuberbier T, Canonica G Walter
Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy.
Asthma Res Pract. 2016 Oct 28;2:12. doi: 10.1186/s40733-016-0027-5. eCollection 2016.
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GALEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician's considerations of disease features, phenotype, and response to previous therapy. This article is being co-published in and the .
能够让我们识别、评估和检测哮喘与慢性阻塞性肺疾病（COPD）中小气道的证据，促使国际哮喘协会（全球哮喘协会）和世界变态反应组织就小气道在这些疾病中的作用表明立场。基于广泛的文献综述，这两个组织制定、讨论并批准了该宣言，随后该宣言得到了变应性鼻炎及其对哮喘的影响（ARIA）和盖伦（GALEN）主席的批准和认可。该宣言描述了迄今为止收集到的证据，并界定和提出了哮喘和COPD中小气道受累及管理方面的问题，目的是挑战既有观念、促进投入并带来改变。小气道（定义为内径<2毫米的气道）参与哮喘和COPD的发病机制，并且是这些疾病气流受限的主要决定因素。有多种检测方法可用于评估小气道，其结果必须综合起来以确诊小气道功能障碍。在哮喘和COPD中，小气道在实现疾病控制和更好预后的努力中起着关键作用。小颗粒吸入制剂（定义为因其大小[通常<2μm]而比大分子更能确保在肺周边更广泛沉积的制剂）已被证明对哮喘和COPD患者有益，尤其是那些以小气道受累为主的患者。需要能够准确评估肺周边的功能和生物学工具，并更深入地使用现有工具。对于疑似COPD或哮喘患者，必须使用现有工具评估小气道受累情况。对于疾病控制不佳和/或有疾病活动的功能或生物学迹象的患者，应评估小气道受累的作用并调整治疗方案。因此，大颗粒和小颗粒吸入制剂之间的选择必须反映医生对疾病特征、表型和既往治疗反应的考虑。本文将同时发表于 和 。
