Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma Global Asthma Association - GAA and World Allergy Organization WAO document endorsed by Allergic Rhinitis and iReport as inadecuate




Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma Global Asthma Association - GAA and World Allergy Organization WAO document endorsed by Allergic Rhinitis and i - Download this document for free, or read online. Document in PDF available to download.

World Allergy Organization Journal

, 9:37

First Online: 28 October 2016Received: 01 June 2016Accepted: 24 August 2016

Abstract

Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease COPD has led INTERASMA Global Asthma Association and WAO to take a position on the role of the small airways in these diseases.

Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GALEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change.

The small airways defined as those with an internal diameter <2 mm are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction.

In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations defined as those that, owing to their size usually <2 μm, ensure more extensive deposition in the lung periphery than large molecules have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant.

Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and-or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy.

This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.

AbbreviationsARIAAllergic Rhinitis and Its Impact on Asthma

COPDChronic Obstructive Pulmonary Disease

CTComputed Tomography

FEF 25–75%Forced expiratory flow at 25–75 % of forced vital capacity

FEFForced Expiratory Flow

FEV1Forced expiratory volume in the 1st second

GALENGlobal Allergy and Asthma European Network

ICSInhaled Cortico Steroids

ICS-LABAInhaled Cortico Steroids-Long Acting Beta2 Agonist

MeSHMedical Subject Headings

MRIMagnetic Resonance Imaging

WAOWorld Allergy Organization

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Author: F. Braido - N. Scichilone - F. Lavorini - O. S. Usmani - L. Dubuske - L. P. Boulet - R. Mosges - C. Nunes - M. Sanchez-

Source: https://link.springer.com/



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