Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy.
Division of Respiratory Diseases, Ospedale L Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy.
Respir Care. 2020 Sep;65(9):1392-1412. doi: 10.4187/respcare.07237. Epub 2020 Mar 24.
COPD and asthma have different risk factors and pathogenesis, but they share a pathophysiologic hallmark characterized by small airways disease. Although difficult to explore and measure, modifications of distal airways' pathophysiology and biology represent an early sign of obstructive disease and should be researched and assessed in everyday clinical practice. In the last 15 years, computed microtomography scans have shed light on the anatomy and physiology of the so-called silent zone, and research devoted to investigate the effect of inhaled treatments on small airway pathophysiology has been increasing. This narrative review offers a historical summary of researchers and landmark studies that reported, defined, and advanced the research on small airways. We then discuss the latest findings on the role and characteristics of the small airways' inflammatory and cellular structure, and we describe the assessment tools available to detect small airways dysfunction in COPD and asthma and the effect of bronchodilators and inhaled steroids on functional and biological biomarkers. Finally, we analyze the newest technological therapeutic advances aimed at small airways treatment in terms of inhalation devices and small particle size molecules.
COPD 和哮喘有不同的危险因素和发病机制，但它们有一个共同的病理生理学标志，即小气道疾病。虽然难以探索和测量，但远端气道的病理生理学和生物学改变代表了阻塞性疾病的早期迹象，应该在日常临床实践中进行研究和评估。在过去的 15 年中，计算机微断层扫描揭示了所谓的“沉默区”的解剖和生理学，并且越来越多的研究致力于调查吸入治疗对小气道病理生理学的影响。这篇综述性文章提供了对报告、定义和推进小气道研究的研究人员和里程碑式研究的历史总结。然后，我们讨论了关于小气道炎症和细胞结构的最新发现，并描述了用于检测 COPD 和哮喘中小气道功能障碍的评估工具，以及支气管扩张剂和吸入性类固醇对功能和生物学生物标志物的影响。最后，我们分析了针对小气道治疗的最新技术治疗进展，包括吸入装置和小粒径分子。
