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Recent Advances in Chest Medicine |

Dilemmas, confusion, and misconceptions related to small airways directed therapy

Federico Lavorini, Ph.D; Søren Pedersen, Ph.D; Omar S. Usmani, Ph.D
Author and Funding Information

Conflict of interest statement:

FL reports personal fees and honoraria for speaking and advisory boards from AstraZeneca, Boheringer Ingelheim, Chiesi, Cipla, Teva, Zentiva outside the submitted work

SP reports fees for consultancies or speaking from AstraZeneca, Boheringer Ingelheim, GlaxoSmithKline, and Sandoz, outside the submitted work.

OSU. reports grants from AstraZeneca, Chiesi, GlaxoSmithKine, Prosonix, Sandoz, Takeda, Zentiva, personal fees from Aerocrine, Boehringer Ingelheim, Chiesi, Napp, Mundipharma, and Sandoz, outside the submitted work.

All authors are member of the Aerosol Drug Management Improvement Team, a non-profit European consortium of physicians with clinical and research expertise on the topic of inhaled therapy for respiratory diseases.

1Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy

2University of Southern Denmark, Pediatric Research Unit, Kolding Hospital, Kolding, Denmark

3National Heart & Lung Institute, Imperial College London & Royal Brompton Hospital, Airways Disease Section, London, UK

Corresponding author: Federico Lavorini, M.D., Ph.D. Department of Experimental and Clinical Medicine, Careggi University Hospital. Largo Brambilla 3, 50134, Florence, Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.07.035
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Abstract

Over the last decade, there is increasing evidence that the small airways, i. e. airways <2 mm in internal diameter, contribute significantly to the pathophysiology and clinical expression of asthma and chronic obstructive pulmonary disease (COPD). The increased interest in small airways is, at least in part, a result of innovation in small-particle aerosol formulations that better target the distal lung and also advanced physiological methods of assessing small airway responses. Increasing the precision of drug deposition may improve targeting of specific diseases or receptor locations, decrease airway drug exposure and side effects, and thereby increase the efficiency and effectiveness of inhaled drug delivery. The availability of small-particle aerosols of corticosteroid, bronchodilator or their combination, enables a higher total lung deposition, better peripheral lung penetration, and provides added clinical benefit, compared to large-particle aerosol treatment. However, a number of questions remain unanswered on the pragmatic approach relevant in order for clinicians to consider the role of small airways directed therapy in the day-to-day management of their patients with asthma and COPD. We have thus tried to clarify the dilemmas, confusion, and misconceptions related to small airways directed therapy. To this end, we have systematically reviewed all studies on small-particle aerosol therapy in order to address the dilemmas, confusion, and misconceptions related to small airways directed therapy.


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