Respiratory Research Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.
Int J Chron Obstruct Pulmon Dis. 2021 Feb 18;16:351-365. doi: 10.2147/COPD.S280157. eCollection 2021.
The response to treatment and progression of Chronic Obstructive Pulmonary Disease (COPD) varies significantly. Small airways disease (SAD) is being increasingly recognized as a key pathological feature of COPD. Studies have brought forward pathological evidence of small airway damage preceding the development of emphysema and the detection of obstruction using traditional spirometry. In recent years, there has been a renewed interest in the early detection of SAD and this has brought along an increased demand for physiological tests able to identify and quantify SAD. Early detection of SAD allows early targeted therapy and this suggests the potential for altering the course of disease. The aim of this article is to review the evidence available on the physiological testing of small airways. The first half will focus on the role of lung function tests such as maximum mid-expiratory flow, impulse oscillometry and lung clearance index in detecting and quantifying SAD. The role of Computed Tomography (CT) as a radiological biomarker will be discussed as well as the potential of recent CT analysis software to differentiate normal aging of the lungs to pathology. The evidence behind SAD biomarkers sourced from blood as well as biomarkers sourced from sputum and broncho-alveolar lavage (BAL) will be reviewed. This paper focuses on CC-16, sRAGE, PAI-1, MMP-9 and MMP-12.
慢性阻塞性肺疾病（COPD）的治疗反应和进展差异很大。小气道疾病（SAD）越来越被认为是 COPD 的一个关键病理特征。研究提出了小气道损伤在肺气肿发展之前以及使用传统肺活量测定法检测到阻塞的病理证据。近年来，人们对 SAD 的早期检测重新产生了兴趣，这也增加了对能够识别和量化 SAD 的生理测试的需求。SAD 的早期检测可以实现早期靶向治疗，这表明有可能改变疾病进程。本文旨在回顾小气道生理学测试的现有证据。前半部分将重点介绍肺功能测试（如最大中期呼气流量、脉冲振荡和肺清除指数）在检测和量化 SAD 中的作用。还将讨论计算机断层扫描（CT）作为一种放射生物标志物的作用，以及最近的 CT 分析软件区分肺部正常老化与病理学的潜力。将回顾源自血液、源自痰和支气管肺泡灌洗（BAL）的 SAD 生物标志物的证据。本文重点介绍 CC-16、sRAGE、PAI-1、MMP-9 和 MMP-12。
