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.

• MeSH
• antiastmatika terapeutické užití   MeSH
• bronchiální astma * patofyziologie   farmakoterapie   diagnóza   MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• lidé MeSH
• oscilometrie * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• antiastmatika MeSH
• hormony kůry nadledvin MeSH

Background: Small airway dysfunction (SAD) is associated with impaired asthma control, but small airway physiology is not routinely assessed in clinical practice. Previously, we demonstrated impulse oscillometry (IOS)-defined small airway dysfunction (SAD) in dual responders (DRs) upon bronchoprovocation with various allergens. Aim: To compare lung physiology using spirometry and IOS following bronchoprovocation with methacholine (M) and inhaled house dust mite (HDM) extract in corticosteroid-naïve asthmatic subjects. Methods: Non-smoking, clinically stable HDM-allergic asthmatic subjects (18-55 years, FEV1 > 70% of pred.) underwent an M and inhaled HDM challenge on two separate days. Airway response was measured by IOS and spirometry, until a drop in FEV1 ≥ 20% (PC20) from post-diluent baseline (M), and up to 8 h post-allergen (HDM). Early (EAR) and late asthmatic response (LAR) to HDM were defined as ≥20% and ≥15% fall in FEV1 from post-diluent baseline during 0-3 h and 3-8 h post-challenge, respectively. IOS parameters (Rrs5, Rrs20, Rrs5-20, Xrs5, AX, Fres) were compared between mono-responders (MRs: EAR only) and dual responders (EAR + LAR). Correlations between maximal % change from baseline after the two airway challenges were calculated for both FEV1 and IOS parameters. Results: A total of 47 subjects were included (11 MRs; 36 DRs). FEV1 % predicted did not differ between MR and DR at baseline, but DR had lower median PC20M (0.84 (range 0.07-7.51) vs. MR (2.15 (0.53-11.29)); p = 0.036). During the LAR, DRs had higher IOS values than MRs. For IOS parameters (but not for FEV1), the maximal % change from baseline following M and HDM challenge were correlated. PC20M was inversely correlated with the % change in FEV1 and the % change in Xrs5 during the LAR (r= -0.443; p = 0.0018 and r= -0.389; p = 0.0075, respectively). Conclusions: During HDM-induced LAR, changes in small airway physiology can be non-invasively detected with IOS and are associated with increased airway hyperresponsiveness and changes in small airway physiology during methacholine challenge. DRs have a small airways phenotype, which reflects a more advanced airway disease.

• Klíčová slova
• allergen bronchoprovocation test, asthma, impulse oscillometry, lung function, methacholine challenge, small airways,
• Publikační typ
• časopisecké články MeSH

To explore the use of oscillometry as a measure of airway responsiveness, 69 asthmatic children underwent histamine and methacholine bronchoprovocation using dosimeter-MedicAid (Jaeger Co.; Germany) and DeVilbiss nebulizers (DeVilbiss, Bornemouth; England). The mean increase in R5 resistance in challenge testing measured after methacholine with the dosimeter-MedicAid nebulizer was 77.14% compared with 65.05% using histamine. Using the dosimeter-DeVilbiss nebulizer, the mean increases in R5 resistance following methacholine and histamine testing were 57.50% and 59.36%, respectively. The resistance R5 over R20 significantly correlated with forced expiratory volume in 1 second (FEV1). The MedicAid produced a more aggressive challenge than the DeVilbliss nebulizer. Oscillometry can be used to monitor the level of airway hyperresponsiveness following bronchoprovocation tests.

• MeSH
• bronchiální astma diagnóza   patofyziologie   MeSH
• bronchiální hyperreaktivita diagnóza   patofyziologie   MeSH
• bronchoprovokační testy přístrojové vybavení   MeSH
• dítě MeSH
• histamin * MeSH
• lidé MeSH
• methacholinchlorid * MeSH
• mladiství MeSH
• nebulizátory a vaporizátory MeSH
• oscilometrie MeSH
• spirometrie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• histamin * MeSH
• methacholinchlorid * MeSH

• Klíčová slova
• OSCILLOMETRY *,
• MeSH
• oscilometrie * MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• OSCILLOMETRY *, POLAROGRAPHY *,
• MeSH
• oscilometrie * MeSH
• polarografie * MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• ARTERIOSCLEROSIS *, LEG *, OSCILLOMETRY *,
• MeSH
• arterioskleróza * MeSH
• ateroskleróza * MeSH
• bérec * MeSH
• lidé MeSH
• oscilometrie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• ARTERIES/physiology *, OSCILLOMETRY *,
• MeSH
• arterie fyziologie   MeSH
• kardiovaskulární systém * MeSH
• lidé MeSH
• oscilometrie * MeSH
• pružnost * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• BRAIN ELECTROPHYSIOLOGY *, OSCILLOMETRY *,
• MeSH
• elektrofyziologické jevy * MeSH
• elektrofyziologie * MeSH
• lidé MeSH
• mozek fyziologie   MeSH
• oscilometrie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• OSCILLOMETRY *,
• MeSH
• cytarabin * MeSH
• etoposid * MeSH
• karmustin * MeSH
• lidé MeSH
• melfalan * MeSH
• oscilometrie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• cytarabin * MeSH
• etoposid * MeSH
• karmustin * MeSH
• melfalan * MeSH

• Klíčová slova
• BARBITURATES/determination *, OSCILLOMETRY *, POLAROGRAPHY *,
• MeSH
• barbital * MeSH
• barbituráty analýza   MeSH
• fenobarbital * MeSH
• lidé MeSH
• oscilometrie * MeSH
• polarografie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• barbital * MeSH
• barbituráty MeSH
• fenobarbital * MeSH