Improving asthma outcomes: Clinicians' perspectives on peripheral airways

Gregory G King; Li Ping Chung; Omar S Usmani; Kris Nilsen; Bruce R Thompson

doi:10.1016/j.jacig.2024.100228

Improving asthma outcomes: Clinicians' perspectives on peripheral airways

J Allergy Clin Immunol Glob. 2024 Feb 13;3(2):100228. doi: 10.1016/j.jacig.2024.100228. eCollection 2024 May.

Authors

Gregory G King¹, Li Ping Chung², Omar S Usmani³, Kris Nilsen⁴, Bruce R Thompson⁵

Affiliations

¹ Royal North Shore Hospital, Woolcock Institute of Medical Research and Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
² Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Australia.
³ National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Airways Disease Section, London, United Kingdom.
⁴ Department of Health and Medical Sciences, Swinburne University of Technology, Melbourne, Australia.
⁵ Melbourne School of Health Science, University of Melbourne, Melbourne, Australia.

Abstract

Disease of the peripheral (or small) airways is fundamental in asthma, being closely related to symptoms (or lack of control of them), airway hyperresponsiveness, spirometric abnormalities, risk of loss of control, or exacerbations and inflammation. Current technology now allows routine measurement of peripheral airway function. Having a working concept of peripheral airways disease in asthma is arguably very useful to clinicians and beneficial to patients because it allows a more comprehensive assessment of asthma severity (rather than just symptoms alone, which is the norm), tracking of progress or deterioration, and assessing response to treatment. Oscillometry is a sensitive way to monitor the peripheral airways, whereas multiple breath nitrogen washout parameters are excellent measures of future risk. In the longer term, physiologic measurements will be crucial in research to define causes and find new disease-modifying treatments.

Keywords: Asthma management; inhaler particle size; multiple breath nitrogen washout; oscillometry; peripheral airways; respiratory function assessment; small airways dysfunction; treatable trait.