The Relevance of Targeting Treatment to Small Airways in Asthma and COPD.

COPD and asthma have different risk factors and pathogenesis, but they share a pathophysiologic hallmark characterized by small airways disease. Although difficult to explore and measure, modifications of distal airways' pathophysiology and biology represent an early sign of obstructive disease and should be researched and assessed in everyday clinical practice. In the last 15 years, computed microtomography scans have shed light on the anatomy and physiology of the so-called silent zone, and research devoted to investigate the effect of inhaled treatments on small airway pathophysiology has been increasing. This narrative review offers a historical summary of researchers and landmark studies that reported, defined, and advanced the research on small airways. We then discuss the latest findings on the role and characteristics of the small airways' inflammatory and cellular structure, and we describe the assessment tools available to detect small airways dysfunction in COPD and asthma and the effect of bronchodilators and inhaled steroids on functional and biological biomarkers. Finally, we analyze the newest technological therapeutic advances aimed at small airways treatment in terms of inhalation devices and small particle size molecules.

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Déclaration de conflit d'intérêts

Dr Santus has disclosed relationships with Chiesi Farmaceutici, AirLiquide, Pfizer, Almirall, Astra Zeneca, Boehringer Ingelheim, Novartis, Menarini, Malesci/Guidotti, Mundipharma, and Zambon. Dr Radovanovic has disclosed relationships with Boehringer Ingelheim, Astra Zeneca, and Neopharmed Gentili. Dr Patella has disclosed relationships with Astra Zeneca, Menarini, and the Italian Drug Agency (AIFA). Dr Braido has disclosed relationships with AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, Dompè, GlaxoSmithKline, Lallemand Pharma, Malesci/Guidotti, Menarini Group, Mundipharma, Novartis, Teva, and Zambon. The remaining authors have disclosed no conflicts of interest.