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Treatment of the bronchial tree from beginning to end: Targeting small airway inflammation in asthma

机译：从始至终治疗支气管树：针对哮喘中的小气道炎症

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Asthma is a chronic respiratory disease, characterized by airway obstruction and inflammation. Increasing evidence shows that the small airways contribute significantly to the clinical expression and severity of asthma. Traditionally, high levels of disease activity are thought to be necessary before symptoms occur in the small airways because of their large reserve capacity. However, this concept is being challenged and increasing evidence shows small airway disease to be associated with symptoms, disease severity, and bronchial hyper-responsiveness. Particle size and distribution are of key importance when developing inhaled treatments for small airway disease. The availability of small-particle aerosols such as HFA-ciclesonide and HFA-beclomethasone dipropionate (HFA-BDP) enables a higher drug deposition into the peripheral lung and potentially provides additional clinical benefits compared with large-particle treatment. However, improved methods are needed to monitor and assess small airway disease and its response to treatment because conventional spirometry mainly reflects large airway function. This remains a challenging area requiring further research. The aim of the current manuscript is to review the clinical relevance of small airway disease and the implications for the treatment of asthma.
机译：哮喘是一种慢性呼吸系统疾病，其特征在于气道阻塞和炎症。越来越多的证据表明，小气道对哮喘的临床表现和严重程度起了重要作用。传统上，由于其大的储备能力，人们认为在小气道出现症状之前必须有高水平的疾病活动性。但是，这一概念正在受到挑战，越来越多的证据表明，小气道疾病与症状，疾病严重程度和支气管高反应性有关。在开发小气道疾病的吸入治疗方法时，粒径和分布至关重要。小颗粒气雾剂（例如HFA-克索奈德和HFA-倍氯米松二丙酸酯（HFA-BDP））的可获得性使药物在外周肺中的沉积更高，并且与大颗粒疗法相比，可能提供更多的临床益处。但是，由于常规肺活量测定法主要反映了较大的气道功能，因此需要改进的方法来监测和评估小气道疾病及其对治疗的反应。这仍然是一个充满挑战的领域，需要进一步研究。本论文的目的是回顾小气道疾病的临床相关性及其对哮喘治疗的意义。

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