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Do small airway abnormalities characterize asthma phenotypes? In search of proof

机译：小气道异常是哮喘表型的特征吗？寻找证据

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Summary: The role of small airway abnormalities in asthma pathogenesis has been extensively studied and debated for several decades. However, whether or not small airway abnormalities play a relevant role in specific phenotypes of asthmatic patients and contribute to clinical presentation is largely unknown. In the present review, we evaluated available data on the role of small airways in severe asthma, with a further focus on asthma in smokers and asthma in the elderly. These phenotypes are characterized by a poor response to treatment and they can represent a model of greater small airway impairment. In severe asthmatics, small airway involvement has been shown through evidence of both distal inflammation and of increased air trapping. The few available data on asthmatics who smoke, and elderly asthmatics, similarly suggests that small airway abnormalities contribute to the pathogenesis of the disease. In this perspective, there could be a rationale for specifically assessing small airway impairment in these patients and for clinical studies evaluating whether pharmacological approaches targeting the more peripheral airways result in clinical benefits beyond conventional therapy.
机译：简介：小气道异常在哮喘发病机制中的作用已被广泛研究和争论了数十年。然而，小气道异常是否在哮喘患者的特定表型中起相关作用并有助于临床表现尚不清楚。在本综述中，我们评估了小气道在严重哮喘中的作用的可用数据，并进一步关注吸烟者的哮喘和老年人的哮喘。这些表型的特征在于对治疗的不良反应，它们可以代表更大的小气道损伤模型。在严重的哮喘患者中，通过远端发炎和空气滞留增加的证据显示出小气道受累。很少有关于吸烟者和老年哮喘者的可用数据类似地表明，较小的气道异常有助于该病的发病。从这个角度来看，可能有一个理由专门评估这些患者的小气道损伤，并进行临床研究，评估针对更多外周气道的药理学方法是否会产生超越传统疗法的临床益处。

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