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Small Airways: The “Silent Zone” of 2021 GINA Report?

Asthma is a chronic disease, affecting approximately 350 million people worldwide. Inflammation and remodeling in asthma involve the large airways, and it is now widely accepted that the small airways (those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and are the m...

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Autores principales: Cottini, Marcello, Lombardi, Carlo, Passalacqua, Giovanni, Bagnasco, Diego, Berti, Alvise, Comberiati, Pasquale, Imeri, Gianluca, Landi, Massimo, Heffler, Enrico
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168121/
https://www.ncbi.nlm.nih.gov/pubmed/35677830
http://dx.doi.org/10.3389/fmed.2022.884679
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author Cottini, Marcello
Lombardi, Carlo
Passalacqua, Giovanni
Bagnasco, Diego
Berti, Alvise
Comberiati, Pasquale
Imeri, Gianluca
Landi, Massimo
Heffler, Enrico
author_facet Cottini, Marcello
Lombardi, Carlo
Passalacqua, Giovanni
Bagnasco, Diego
Berti, Alvise
Comberiati, Pasquale
Imeri, Gianluca
Landi, Massimo
Heffler, Enrico
author_sort Cottini, Marcello
collection PubMed
description Asthma is a chronic disease, affecting approximately 350 million people worldwide. Inflammation and remodeling in asthma involve the large airways, and it is now widely accepted that the small airways (those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and are the major determinant of airflow obstruction in this disease. From a clinical perspective, small airways dysfunction (SAD) is associated with more severe bronchial hyperresponsiveness, worse asthma control and more exacerbations. Unlike the GOLD guidelines which, in their definition, identify COPD as a disease of the small airways, the Global Initiative for Asthma (GINA) guidelines do not refer to the prevalence and role of SAD in asthmatic patients. This decision seems surprising, given the growing body of compelling evidence accumulating pointing out the high prevalence of SAD in asthmatic patients and the importance of SAD in poor asthma control. Furthermore, and remarkably, SAD appears to possess the characteristics of a treatable pulmonary trait, making it certainly appealing for asthma control optimization and exacerbation rate reduction. In this mini-review article, we address the most recent evidence on the role of SAD on asthma control and critically review the possible inclusion of SAD among treatable pulmonary traits in international guidelines on asthma.
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spelling pubmed-91681212022-06-07 Small Airways: The “Silent Zone” of 2021 GINA Report? Cottini, Marcello Lombardi, Carlo Passalacqua, Giovanni Bagnasco, Diego Berti, Alvise Comberiati, Pasquale Imeri, Gianluca Landi, Massimo Heffler, Enrico Front Med (Lausanne) Medicine Asthma is a chronic disease, affecting approximately 350 million people worldwide. Inflammation and remodeling in asthma involve the large airways, and it is now widely accepted that the small airways (those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and are the major determinant of airflow obstruction in this disease. From a clinical perspective, small airways dysfunction (SAD) is associated with more severe bronchial hyperresponsiveness, worse asthma control and more exacerbations. Unlike the GOLD guidelines which, in their definition, identify COPD as a disease of the small airways, the Global Initiative for Asthma (GINA) guidelines do not refer to the prevalence and role of SAD in asthmatic patients. This decision seems surprising, given the growing body of compelling evidence accumulating pointing out the high prevalence of SAD in asthmatic patients and the importance of SAD in poor asthma control. Furthermore, and remarkably, SAD appears to possess the characteristics of a treatable pulmonary trait, making it certainly appealing for asthma control optimization and exacerbation rate reduction. In this mini-review article, we address the most recent evidence on the role of SAD on asthma control and critically review the possible inclusion of SAD among treatable pulmonary traits in international guidelines on asthma. Frontiers Media S.A. 2022-05-23 /pmc/articles/PMC9168121/ /pubmed/35677830 http://dx.doi.org/10.3389/fmed.2022.884679 Text en Copyright © 2022 Cottini, Lombardi, Passalacqua, Bagnasco, Berti, Comberiati, Imeri, Landi and Heffler. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Cottini, Marcello
Lombardi, Carlo
Passalacqua, Giovanni
Bagnasco, Diego
Berti, Alvise
Comberiati, Pasquale
Imeri, Gianluca
Landi, Massimo
Heffler, Enrico
Small Airways: The “Silent Zone” of 2021 GINA Report?
title Small Airways: The “Silent Zone” of 2021 GINA Report?
title_full Small Airways: The “Silent Zone” of 2021 GINA Report?
title_fullStr Small Airways: The “Silent Zone” of 2021 GINA Report?
title_full_unstemmed Small Airways: The “Silent Zone” of 2021 GINA Report?
title_short Small Airways: The “Silent Zone” of 2021 GINA Report?
title_sort small airways: the “silent zone” of 2021 gina report?
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168121/
https://www.ncbi.nlm.nih.gov/pubmed/35677830
http://dx.doi.org/10.3389/fmed.2022.884679
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