哮喘的小气道:从炎症和病理生理学到治疗反应。
Small airways in asthma: From inflammation and pathophysiology to treatment response.
机构信息
1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece.
1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Athens, Greece.
出版信息
Respir Med. 2024 Feb;222:107532. doi: 10.1016/j.rmed.2024.107532. Epub 2024 Jan 14.
Small airways are characterized as those with an inner diameter less than 2 mm and constitute a major site of pathology and inflammation in asthma disease. It is estimated that small airways dysfunction may occur before the emergence of noticeable symptoms, spirometric abnormalities and imaging findings, thus characterizing them as "the quiet or silent zone" of the lungs. Despite their importance, measuring and quantifying small airways dysfunction presents a considerable challenge due to their inaccessibility in usual functional measurements, primarily due to their size and peripheral localization. Several pulmonary function tests have been proposed for the assessment of the small airways, including impulse oscillometry, nitrogen washout, body plethysmography, as well as imaging methods. Nevertheless, none of these methods has been established as the definitive "gold standard," thus, a combination of them should be used for an effective assessment of the small airways. Widely used asthma treatments seem to also affect several parameters of the small airways. Emerging biologic treatments show promising results in reducing small airways inflammation and remodelling, providing evidence for potential alterations in the disease's progression and outcomes. These novel therapies have implications not only in the clinical aspects of asthma but also in its inflammatory and functional aspects.
小气道的特征为内径小于 2mm,并在哮喘疾病中构成主要的病理学和炎症部位。据估计,小气道功能障碍可能在出现明显症状、肺量计异常和影像学发现之前发生,因此将其特征化为肺部的“安静或沉默区”。尽管它们很重要,但由于其在常规功能测量中的不可及性,尤其是由于其大小和周围定位,测量和量化小气道功能障碍提出了相当大的挑战。已经提出了几种用于评估小气道的肺功能测试,包括脉冲振荡法、氮气洗脱法、体描法以及影像学方法。然而,这些方法都没有被确立为明确的“金标准”,因此,应该将它们结合起来以有效地评估小气道。广泛使用的哮喘治疗方法似乎也会影响小气道的几个参数。新兴的生物治疗方法显示出在减少小气道炎症和重塑方面有很好的效果,为疾病进展和结局的潜在改变提供了证据。这些新的治疗方法不仅对哮喘的临床方面,而且对其炎症和功能方面都有影响。