Clinical Reviews in Allergy & Immunology ( IF 9.1 ) Pub Date : 2020-11-26 , DOI: 10.1007/s12016-020-08818-1 Russell J Hopp 1 , Mark C Wilson 1 , M Asghar Pasha 2
Asthma affects all portions of the airways. Small airways, however, comprise a substantial component of the conducting lung air flow. In asthma, inflammatory processes can affect the whole respiratory tract, from central to peripheral/small airways. The emphasis in adult and pediatric respiratory disease clinics is to focus on large airway obstruction and reversibility. This information, although valuable, underemphasizes a large portion of the conduction airway of asthmatics. Standard descriptions of asthma management focus on a multiple medication approaches. We particularly focused on the management of asthma in the international guidelines for the Global Initiative for Asthma (GINA). Overall, however, minimal attention is placed on the small airway pool in asthma medical management. We took the opportunity to thoroughly review and present specific data from the adult asthma literature which supported the concept that small airway abnormalities may play a role in the pathogenesis and clinical expression of asthma. Based on the conclusions of the adult asthma literature, we here present a thorough review of the literature as it relates to small airway disease in children with asthma. We used, collectively, individual data sources of data to expand the information available from standard diagnostic techniques, especially spirometry, in the evaluation of small airway disease. As the pharmacological approaches to moderate to severe asthma are advancing rapidly into the realm of biologics, we sought to present potential pharmacological options for small airway dysfunction in pediatrics prior to biological modifier intervention.
中文翻译:
小儿哮喘中的小气道疾病:谁、什么、何时、何地、为什么以及如何治疗。回顾与评论
哮喘影响气道的所有部分。然而,小气道构成了传导肺气流的重要组成部分。在哮喘中,炎症过程会影响整个呼吸道,从中央到外周/小气道。成人和儿童呼吸道疾病诊所的重点是关注大气道阻塞和可逆性。这些信息虽然很有价值,但低估了哮喘患者的大部分传导气道。哮喘管理的标准描述集中在多种药物治疗上。我们特别关注全球哮喘倡议 (GINA) 国际指南中的哮喘管理。然而,总体而言,哮喘医疗管理中对小气道池的关注很少。我们借此机会彻底回顾并提供了来自成人哮喘文献的特定数据,这些数据支持小气道异常可能在哮喘的发病机制和临床表现中发挥作用的概念。基于成人哮喘文献的结论,我们在此全面回顾与哮喘儿童小气道疾病相关的文献。在评估小气道疾病时,我们共同使用单个数据源来扩展标准诊断技术(尤其是肺活量测定法)可获得的信息。随着中度至重度哮喘的药理学方法正在迅速进入生物制剂领域,我们试图在生物调节剂干预之前为儿科小气道功能障碍提供潜在的药理学选择。