Treatment of the bronchial tree from beginning to end: targeting small airway inflammation in asthma

Authors

  • M. van den Berge,

    Corresponding author
    1. GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands
    • Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
    Search for more papers by this author
  • N. H. T. ten Hacken,

    1. Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
    2. GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands
    Search for more papers by this author
  • E. van der Wiel,

    1. Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
    2. GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands
    Search for more papers by this author
  • D. S. Postma

    1. Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
    2. GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands
    Search for more papers by this author

  • Edited by: Michael Wechsler

Correspondence

Dr. M. van den Berge, Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Tel.: +31-50-3613532

Fax: +31-50-3619320

E-mail: m.van.den.berge@umcg.nl

Abstract

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.

Ancillary