Edited by: Michael Wechsler
Treatment of the bronchial tree from beginning to end: targeting small airway inflammation in asthma
Article first published online: 9 NOV 2012
© 2012 John Wiley & Sons A/S
Volume 68, Issue 1, pages 16–26, January 2013
How to Cite
Treatment of the bronchial tree from beginning to end: targeting small airway inflammation in asthma. Allergy 2012; DOI: 10.1111/all.12062., , , .
- Issue published online: 4 DEC 2012
- Article first published online: 9 NOV 2012
- Manuscript Accepted: 27 SEP 2012
- Takeda Pharmaceuticals International GmbH
- HFA-beclomethasone dipropionate;
- particle size;
- small airways
Asthma is a chronic respiratory disease, characterized by airway obstruction and inflammation. Increasing evidence shows that the small airways contribute significantly to the clinical expression and severity of asthma. Traditionally, high levels of disease activity are thought to be necessary before symptoms occur in the small airways because of their large reserve capacity. However, this concept is being challenged and increasing evidence shows small airway disease to be associated with symptoms, disease severity, and bronchial hyper-responsiveness. Particle size and distribution are of key importance when developing inhaled treatments for small airway disease. The availability of small-particle aerosols such as HFA-ciclesonide and HFA-beclomethasone dipropionate (HFA-BDP) enables a higher drug deposition into the peripheral lung and potentially provides additional clinical benefits compared with large-particle treatment. However, improved methods are needed to monitor and assess small airway disease and its response to treatment because conventional spirometry mainly reflects large airway function. This remains a challenging area requiring further research. The aim of the current manuscript is to review the clinical relevance of small airway disease and the implications for the treatment of asthma.