Frizzelli A.a,b· Nicolini G.c· Chetta A.a,b

Author affiliations

aDepartment of Medicine & Surgery, University of Parma, Parma, Italy
bPneumology and Lung Function Unit, University Hospital, Parma, Italy
cChiesi Farmaceutici S.p.A., Parma, Italy

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Access via DeepDyve Unlimited fulltext viewing Of this article Organize, annotate And mark up articles Printing And downloading restrictions apply

Select

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Received: December 23, 2021
Accepted: May 23, 2022
Published online: July 12, 2022

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 1

ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)

For additional information: https://www.karger.com/RES

Abstract

The airways smaller than 2 mm diameter are named small airways. They are essential for the transport and exchange of oxygen and carbon dioxide and at the same time play a relevant role in pulmonary mechanics, contributing to the subdivision of lung volumes. Measurement of small airway function is, therefore, crucial in patients with respiratory disease. This overview focuses on the physiological aspects of the small airways, considered as air ducts as well as determinants of pulmonary mechanics, the most common tools for evaluating their function and treatment implications.

© 2022 S. Karger AG, Basel

References Hogg JC, Paré PD, Hackett TL. The contribution of small airway obstruction to the pathogenesis of chronic obstructive pulmonary disease. Physiol Rev. 2017 Apr;97(2):529–52. Macklem PT, Mead J. Resistance of central and peripheral airways measured by a retrograde catheter. J Appl Physiol. 1967 Mar;22(3):395–401. Weibel ER. Morphometry of the human lung. New York: Academic Press; 1963. Hogg JC, Macklem PT, Thurlbeck WM. The resistance of small airways in normal and diseased human lungs. Aspen Emphysema Conf. 1967;10:433–41. Van Scott MR, Chandler J, Olmstead S, Brown JM, Mannie M. Airway anatomy, physiology, and inflammation. In: Meggs W, editor. The toxicant induction of irritant asthma, rhinitis, and related conditions. Boston, MA: Springer; 2013. Pisi R, Aiello M, Frizzelli A, Calzetta L, Marchi L, Bertorelli G, et al. Detection of small airway dysfunction in asymptomatic smokers with preserved spirometry: the value of the impulse oscillometry system. Int J Chron Obstruct Pulmon Dis. 2021;16:2585–90. McDonough JE, Yuan R, Suzuki M, Seyednejad N, Elliott WM, Sanchez PG, et al. Small-airway obstruction and emphysema in chronic obstructive pulmonary disease. N Engl J Med. 2011 Oct 27;365(17):1567–75. Chetta A. “Unpublished lab data”. Cooper CB, Dransfield M. Primary care of the patient with chronic obstructive pulmonary disease-part 4: understanding the clinical manifestations of a progressive disease. Am J Med. 2008 Jul;121(7):S33–45. Crisafulli E, Pisi R, Aiello M, Vigna M, Tzani P, Torres A, et al. Prevalence of small-airway dysfunction among COPD patients with different GOLD stages and its role in the impact of disease. Respiration. 2017;93(1):32–41. Manco A, Pisi R, Aiello M, Tzani P, Frizzelli A, Fantin A, et al. Small airway dysfunction predicts excess ventilation and dynamic hyperinflation during exercise in patients with COPD. Respir Med X. 2020;2:100020. Chetta A, Aiello M, Zanini A, Tzani P, Paleari D, Marangio E, et al. Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015 Jun 19;10:1191–7. Alfieri V, Aiello M, Pisi R, Tzani P, Mariani E, Marangio E, et al. Small airway dysfunction is associated to excessive bronchoconstriction in asthmatic patients. Respir Res. 2014 Aug 27;15(1):86. van der Wiel E, ten Hacken NH, Postma DS, van den Berge M. Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: a systematic review. J Allergy Clin Immunol. 2013;131(3):646–57. Postma DS, Brightling C, Baldi S, Van den Berge M, Fabbri LM, Gagnatelli A, et al. Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study. Lancet Respir Med. 2019 May;7(5):402–16. Bonini M, Usmani OS. The role of the small airways in the pathophysiology of asthma and chronic obstructive pulmonary disease. Ther Adv Respir Dis. 2015;9(6):281–93. Cosio M, Ghezzo H, Hogg JC, Corbin R, Loveland M, Dosman J, et al. The relations between structural changes in small airways and pulmonary-function tests. N Engl J Med. 1978;298(23):1277–81. Lebecque P, Kiakulanda P, Coates AL. Spirometry in the asthmatic child: is FEF25-75 a more sensitive test than FEV1/FVC? Pediatr Pulmonol. 1993 Jul;16(1):19–22. Szefler SJ, Goldstein S, Vogelberg C, Bensch GW, Given J, Jugovic B, et al. Forced expiratory flow (FEF25–75%) as a clinical endpoint in children and adolescents with symptomatic asthma receiving tiotropium: a post hoc analysis. Pulm Ther. 2020;6(2):151–8. Quanjer PH, Weiner DJ, Pretto JJ, Brazzale DJ, Boros PW. Measurement of FEF25-75% and FEF75% does not contribute to clinical decision making. Eur Respir J. 2014 Apr;43(4):1051–8. Sutherland ER, Martin RJ, Bowler RP, Zhang Y, Rex MD, Kraft M. Physiologic correlates of distal lung inflammation in asthma. J Allergy Clin Immunol. 2004;113(6):1046–50. Hansen JE, Sun XG, Wasserman K. Discriminating measures and normal values for expiratory obstruction. Chest. 2006 Feb;129(2):369–77. Dilektasli AG, Porszasz J, Casaburi R, Stringer WW, Bhatt SP, Pak Y, et al. A Novel spirometric measure identifies mild COPD unidentified by standard criteria. Chest. 2016 Nov;150(5):1080–90. Perez T, Chanez P, Dusser D, Devillier P. Small airway impairment in moderate to severe asthmatics without significant proximal airway obstruction. Respir Med X. 2013;107(11):1667–74. Turato G, Zuin R, Miniati M, Baraldo S, Rea F, Beghé B, et al. Airway inflammation in severe chronic obstructive pulmonary disease: relationship with lung function and radiologic emphysema. Am J Respir Crit Care Med. 2002;166(1):105–10. Kraft M, Pak J, Martin RJ, Kaminsky D, Irvin CG. Distal lung dysfunction at night in nocturnal asthma. Am J Respir Crit Care Med. 2001;163(7):1551–6. Goldman MD, Saadeh C, Ross D. Clinical applications of forced oscillation to assess peripheral airway function. Respir Physiol Neurobiol. 2005;148(1–2):179–94. Nicolini G, Scichilone N, Bizzi A, Papi A, Fabbri LM. Beclomethasone/formoterol fixed combination for the management of asthma: patient considerations. Ther Clin Risk Manag. 2008 Oct;4(5):855–64. Pisi R, Aiello M, Piraino A, Paleari D, Frizzelli A, Bertorelli G, et al. Beclomethasone/formoterol in extra-fine formulation improves small airway dysfunction in COPD patients. Pulm Ther. 2021 Jun;7(1):133–43. Kraft M, Cairns CB, Ellison MC, Pak J, Irvin C, Wenzel S. Improvements in distal lung function correlate with asthma symptoms after treatment with oral montelukast. Chest. 2006 Dec;130(6):1726–32. Dean J, Panainte C, Khan N, Singh D. The TRIFLOW study: a randomised, cross-over study evaluating the effects of extrafine beclometasone/formoterol/glycopyrronium on gas trapping in COPD. Respir Res. 2020;21(1):323. Parker CM, Voduc N, Aaron SD, Webb KA, O’Donnell DE. Physiological changes during symptom recovery from moderate exacerbations of COPD. Eur Respir J. 2005 Sep;26(3):420–8. Mahler DA, O’Donnell DE. Recent advances in dyspnea. Chest. 2015 Jan;147(1):232–41. Sayiner A, Aytemur ZA, Cirit M, Unsal I. Systemic glucocorticoids in severe exacerbations of COPD. Chest. 2001 Mar;119(3):726–30. Zeidler MR, Kleerup EC, Goldin JG, Kim HJ, Truong DA, Simmons MD, et al. Montelukast improves regional air-trapping due to small airways obstruction in asthma. Eur Respir J. 2006 Feb;27(2):307–15. Farah CS, Badal T, Reed N, Rogers PG, King GG, Thamrin C, et al. Mepolizumab improves small airway function in severe eosinophilic asthma. Respir Med X. 2019 Mar;148:49–53. Crisafulli E, Zanini A, Pisi G, Pignatti P, Poli G, Scuri M, et al. Inhaled beclometasone dipropionate/formoterol fumarate extrafine fixed combination for the treatment of asthma. Expert Rev Respir Med. 2016;10(5):481–90. Usmani OS, Han MK, Kaminsky DA, Hogg J, Hjoberg J, Patel N, et al. Seven pillars of small airways disease in asthma and COPD: supporting opportunities for novel therapies. Chest. 2021 Jul;160(1):114–34. Lipworth B, Manoharan A, Anderson W. Unlocking the quiet zone: the small airway asthma phenotype. Lancet Respir Med. 2014 Jun;2(6):497–506. O’Donnell DE, Laveneziana P. Physiology and consequences of lung hyperinflation in COPD. Eur Respir Rev. 2006;15(100):61–7. Lipworth BJ, Jabbal S. What can we learn about COPD from impulse oscillometry? Respir Med X. 2018 Jun;139:106–9. Article / Publication Details

First-Page Preview

Received: December 23, 2021
Accepted: May 23, 2022
Published online: July 12, 2022

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 1

ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)

For additional information: https://www.karger.com/RES

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.