Seven Pillars of Small Airways Disease in Asthma and COPD: Supporting Opportunities for Novel Therapies.

Autor: Usmani OS; National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, UK. Electronic address: o.usmani@imperial.ac.uk., Han MK; Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI., Kaminsky DA; Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Burlington, VT., Hogg J; James Hogg Research Centre, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada., Hjoberg J; formerly of AstraZeneca, Gothenburg, Sweden., Patel N; Sanofi Genzyme, Boston, MA., Hardin M; Sanofi Genzyme, Boston, MA., Keen C; Research and Early Development, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden., Rennard S; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Translational Science and Experimental Medicine, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK., Blé FX; Translational Science and Experimental Medicine, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK., Brown MN; Research and Early Development, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Boston, MA.
Jazyk: angličtina
Zdroj: Chest [Chest] 2021 Jul; Vol. 160 (1), pp. 114-134. Date of Electronic Publication: 2021 Apr 02.
DOI: 10.1016/j.chest.2021.03.047
Abstrakt: Identification of pathologic changes in early and mild obstructive lung disease has shown the importance of the small airways and their contribution to symptoms. Indeed, significant small airways dysfunction has been found prior to any overt airway obstruction being detectable by conventional spirometry techniques. However, most therapies for the treatment of obstructive lung disease target the physiological changes and associated symptoms that result from chronic lung disease, rather than directly targeting the specific underlying causes of airflow disruption or the drivers of disease progression. In addition, although spirometry is the current standard for diagnosis and monitoring of response to therapy, the most widely used measure, FEV 1 , does not align with the pathologic changes in early or mild disease and may not align with symptoms or exacerbation frequency in the individual patient. Newer functional and imaging techniques allow more effective assessment of small airways dysfunction; however, significant gaps in our understanding remain. Improving our knowledge of the role of small airways dysfunction in early disease in the airways, along with the identification of novel end points to measure subclinical changes in this region (ie, those not captured as symptoms or identified through standard FEV 1 ), may lead to the development of novel therapies that directly combat early airways disease processes with a view to slowing disease progression and reversing damage. This expert opinion paper discusses small airways disease in the context of asthma and COPD and highlights gaps in current knowledge that impede earlier identification of obstructive lung disease and the development and standardization of novel small airways-specific end points for use in clinical trials.
(Copyright © 2021. Published by Elsevier Inc.)
Databáze: MEDLINE
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