The small airways, also referred to as the lung's silent zone, are closely associated with poor symptom control and more frequent asthma exacerbations. The oscillometry technique superimposes sound or airwaves onto normal tidal breathing and provides information on resistance and reactance, that is, obstacles to airflow occurring inside and outside of the bronchi. More recently, a management paradigm based on so-called "treatable traits" has been proposed to personalize and improve asthma care for individuals by proactively identifying and targeting modifiable pulmonary, extrapulmonary, and behavioral traits affecting asthma control. In this review article, we evaluate the literature on small airways dysfunction as a potential treatable trait in persistent asthma. In particular, we discuss whole- and intrabreath oscillometry and the impact of extrafine inhaled corticosteroids and systemic biologics on the peripheral airways.

Allergy and Pneumology Outpatient Clinic Bergamo Italy

Department of Cellular Computational and Integrative Biology University of Trento Trento Italy

Department of Clinical Pharmacy and Pharmacology University Medical Centre Groningen Groningen The Netherlands; Department of Microbiology Immunology and Transplantation Ku Leuven Leuven Belgium; Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Departmental Unit of Allergology Immunology and Pulmonary Diseases Fondazione Poliambulanza Brescia Italy

Faculty of Medicine and Health Sciences McGill University Montreal Canada; Oscillometry Unit and Centre for Innovative Medicine of the McGill University Health Centre and Research Institute Meakins Christie Labs Montreal Chest Institute Montreal Canada; Lakeshore General Hospital Pointe Claire Canada; Ste Anne Hospital Ste Anne de Bellevue Canada

Pulmonology Unit S Valentino Hospital Montebelluna Marca Trevigiana Italy

Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy

University of Dundee School of Medicine Dundee United Kingdom

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