Tuberc Respir Dis.  2017 Oct;80(4):317-324. 10.4046/trd.2017.0080.

Small Airway Disease in Patients with Chronic Obstructive Pulmonary Disease

• Singh D

• KMID: 2420573
• DOI: http://doi.org/10.4046/trd.2017.0080

Abstract

Small airway disease (SAD) has been recognized for many years as a central feature of chronic obstructive pulmonary disease (COPD). Histopathology studies have shown that the narrowing and destruction of small airways in COPD combined with inflammatory cell infiltration in the submucosa increases the severity of the disease. SAD is present in the early stages of COPD and becomes more widespread over time as the disease progresses to more severe COPD. The development of inhalers containing extra-fine particles allows the small airways to be pharmacologically targeted. Recent clinical trials have shown the efficacy of extra-fine triple therapy that targets the small airways in patients with COPD. This article reviews the importance and treatment of SAD in COPD.

Keyword

Particle Size; Therapeutics; Pulmonary Disease, Chronic Obstructive

MeSH Terms

Humans
Nebulizers and Vaporizers
Particle Size
Pulmonary Disease, Chronic Obstructive*

Figure

• 

  Figure 1 Lung function measurements in chronic obstructive pulmonary disease patients with and without expiratory flow limitation (EFL)23. (A) EFL patients have worse airflow obstruction and more hyperinflation measured by residual volume (RV) and total lung capacity (TLC). (B) EFL patients have more impulse oscillometry evidence of small airway disease (R5 and R5–R20). All differences between groups in panels (A) and (B) are statistically significant (p<0.05). FEV1: forced expiratory volume in 1 second.

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  Figure 2 Parametric response mapping (PRM) using computed tomography imaging in chronic obstructive pulmonary disease patients of different severities24. Percentage of voxels with functional small airway disease (fSAD) and emphysema shown. GOLD: Global Initiative for Obstructive Lung Disease.

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