Small airway disease: A new “phenotype” of obstructive airway disease

Small airways are usually defined as noncartilaginous airways with an internal diameter <2 mm. Robust data are available regarding small airway involvement in various obstructive airway diseases such as bronchial asthma and chronic obstructive pulmonary disease (COPD). Small airway disease (SAD)...

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Main Authors: Shital Patil, Sham Toshniwal, Gajanan Gondhali
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2023-01-01
Series:Annals of Medical Science and Research
Subjects:
Online Access:https://journals.lww.com/10.4103/amsr.amsr_2_23
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author Shital Patil
Sham Toshniwal
Gajanan Gondhali
author_facet Shital Patil
Sham Toshniwal
Gajanan Gondhali
author_sort Shital Patil
collection DOAJ
description Small airways are usually defined as noncartilaginous airways with an internal diameter <2 mm. Robust data are available regarding small airway involvement in various obstructive airway diseases such as bronchial asthma and chronic obstructive pulmonary disease (COPD). Small airway disease (SAD) can present as a starting point of emphysema, and in few cases, SAD can present with emphysema. Thus, SAD in COPD is a different phenotype along with emphysema and chronic bronchitis. Although bronchial asthma is a disease of large and medium size airways, small airway involvement has been documented in asthma in late stage. Involvement of small airways in asthma is a clinical clue toward the role of inhaled antimuscarinic therapy in this phenotype. Spirometry is a simple and cost-effective but less reliable test to diagnose SAD in comparison to impulse oscillometry. Inhalation therapy with small particle size aerosol long-acting beta-agonist plus inhaled corticosteroids is recommended for treatment of SAD. Targeting small airways in asthma and COPD with ultrafine particle-size inhaled medicines with antimuscarinic drugs will have a successful treatment outcome.
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spelling doaj-art-cbf697f1f0bb428cb387f6451d807a6b2025-08-20T03:59:36ZengWolters Kluwer Medknow PublicationsAnnals of Medical Science and Research2949-785X2949-78682023-01-0121425010.4103/amsr.amsr_2_23Small airway disease: A new “phenotype” of obstructive airway diseaseShital PatilSham ToshniwalGajanan GondhaliSmall airways are usually defined as noncartilaginous airways with an internal diameter <2 mm. Robust data are available regarding small airway involvement in various obstructive airway diseases such as bronchial asthma and chronic obstructive pulmonary disease (COPD). Small airway disease (SAD) can present as a starting point of emphysema, and in few cases, SAD can present with emphysema. Thus, SAD in COPD is a different phenotype along with emphysema and chronic bronchitis. Although bronchial asthma is a disease of large and medium size airways, small airway involvement has been documented in asthma in late stage. Involvement of small airways in asthma is a clinical clue toward the role of inhaled antimuscarinic therapy in this phenotype. Spirometry is a simple and cost-effective but less reliable test to diagnose SAD in comparison to impulse oscillometry. Inhalation therapy with small particle size aerosol long-acting beta-agonist plus inhaled corticosteroids is recommended for treatment of SAD. Targeting small airways in asthma and COPD with ultrafine particle-size inhaled medicines with antimuscarinic drugs will have a successful treatment outcome.https://journals.lww.com/10.4103/amsr.amsr_2_23asthmachronic obstructive pulmonary diseaseobstructive airway diseasesmall airway diseasespirometry
spellingShingle Shital Patil
Sham Toshniwal
Gajanan Gondhali
Small airway disease: A new “phenotype” of obstructive airway disease
Annals of Medical Science and Research
asthma
chronic obstructive pulmonary disease
obstructive airway disease
small airway disease
spirometry
title Small airway disease: A new “phenotype” of obstructive airway disease
title_full Small airway disease: A new “phenotype” of obstructive airway disease
title_fullStr Small airway disease: A new “phenotype” of obstructive airway disease
title_full_unstemmed Small airway disease: A new “phenotype” of obstructive airway disease
title_short Small airway disease: A new “phenotype” of obstructive airway disease
title_sort small airway disease a new phenotype of obstructive airway disease
topic asthma
chronic obstructive pulmonary disease
obstructive airway disease
small airway disease
spirometry
url https://journals.lww.com/10.4103/amsr.amsr_2_23
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AT shamtoshniwal smallairwaydiseaseanewphenotypeofobstructiveairwaydisease
AT gajanangondhali smallairwaydiseaseanewphenotypeofobstructiveairwaydisease