Small airway involvement in bronchial asthma and chronic obstructive pulmonary disease: From understanding pathophysiology to optimizing therapy
Abstract. Small airway involvement (SAI) is a clinically important yet often underestimated component of bronchial asthma and chronic obstructive pulmonary disease (COPD). In this review, SAI is considered both as small airways disease, associated with structural and morphological changes in the bronchioles, and as small airway dysfunction, manifested by peripheral airflow obstruction, ventilation heterogeneity, premature expiratory airway closure, air trapping, and dynamic hyperinflation. A mismatch between symptom burden and standard spirometric indices is frequently related to small airway dysfunction, which is only partly captured by FEV1. The review summarizes current concepts of small airway pathophysiology in asthma and COPD, outlines a diagnostic approach using functional tests and imaging modalities, and substantiates therapeutic strategies that take drug deposition in the peripheral bronchial tree into account. The role of comorbidities and practical aspects of patient management in primary care are addressed separately.O.M. Uryasev, E.S. Belskikh, I.B. Ponomareva, S.I. Glotov, E.V. Aftaeva, E.M. Goldina
Keywords
small airways
bronchial asthma
chronic obstructive pulmonary disease
impulse oscillometry
small airway disease
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About the Authors
Oleg M. Uryasev, MD, Dr. Sci. (Medicine), professor, head of the Department of faculty therapy named after professor V.Ya. Garmash, Academician I.P.Pavlov Ryazan State Medical University, Ryazan, Russian Federation.E-mail: uryasev08@yandex.ru
ORCID: https://orcid.org/0000-0001-8693-4696. еLibrary SPIN: 7903-4609. Scopus ID: 57195313767
Eduard S. Belskikh, MD, PhD (Medicine), associate professor of the Department of faculty therapy named after professor V.Ya. Garmash, Academician I.P.Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
E-mail: ed.bels@yandex.ru
ORCID: https://orcid.org/0000-0003-1803-0542. еLibrary SPIN: 9350-9360. Scopus ID: 57195313786
Irina B. Ponomareva, MD, PhD (Medicine), associate professor of the Department of faculty therapy named after professor V.Ya. Garmash, Academician I.P.Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
E-mail: docib@yandex.ru
ORCID: https://orcid.org/0000-0002-0273-4388. еLibrary SPIN: 3984-1944. Scopus ID: 57201763814
Sergey I. Glotov, MD, PhD (Medicine), associate professor of the Department of faculty therapy named after professor V.Ya. Garmash, Academician I.P.Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
E-mail: sergeyglot@mail.ru
ORCID: https://orcid.org/0000-0002-4445-4480. еLibrary SPIN: 7524-9816. Scopus ID: 57203780371
Elena V. Aftaeva, MD, assistant at the Department of cardiovascular, endovascular and X-ray surgery and diagnostic imaging, Academician I.P.Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
E-mail: aftaeva.elena@gmail.com
ORCID: https://orcid.org/0009-0002-6573-7460. еLibrary SPIN: 9877-2615. Scopus ID: 57223230731
Elena M. Goldina, MD, PhD (Medicine), head of the Department of pulmonology, Regional Clinical Hospital, Ryazan, Russian Federation.
E-mail: goldina.71@mail.ru
ORCID: https://orcid.org/0009-0003-2780-1510
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