Small airways disease: time for a revisit?

Research output: Contribution to journalReview article

Authors

Colleges, School and Institutes

External organisations

  • Department of Lung Function and Sleep.
  • Department of Respiratory Medicine, University Hospital Birmingham.
  • Institute of Inflammation and Ageing, Centre for Translational Inflammation Research, University of Birmingham, Edgbaston, Birmingham, UK.

Abstract

It is increasingly acknowledged that delays in the diagnosis of chronic inflammatory lung conditions have hampered our understanding of pathogenesis and thus our ability to design efficacious therapies. This is particularly true for COPD, where most patients are diagnosed with moderate-to-severe airflow obstruction and little is known about the inflammatory processes present in early disease. There is great interest in developing screening tests that can identify those most at risk of developing COPD before airflow obstruction has developed for the purpose of research and clinical care. Landmark pathology studies have suggested that damage to the small airways precedes the development of airflow obstruction and emphysema and, thus, presents an opportunity to identify those at risk of COPD. However, despite a number of physiological tests being available to assess small airways function, none have been adopted into routine care in COPD. The reasons that tests of small airways have not been utilized widely include variability in test results and a lack of validated reference ranges from which to compare results for some methodologies. Furthermore, population studies have not consistently demonstrated their ability to diagnose disease. However, the landscape may be changing. As the equipment that delivers tests of small airways become more widely available, reference ranges are emerging and newer methodologies specifically seek to address variability and difficulty in test performance. Moreover, there is evidence that while tests of small airways may not be helpful across the full range of established disease severity, there may be specific groups (particularly those with early disease) where they might be informative. In this review, commonly utilized tests of small airways are critically appraised to highlight why these tests may be important, how they can be used and what knowledge gaps remain for their use in COPD.

Details

Original languageEnglish
Pages (from-to)2343-2353
Number of pages11
JournalInternational journal of chronic obstructive pulmonary disease
Volume12
Publication statusPublished - 7 Aug 2017

Keywords

  • Airway Obstruction, Disease Progression, Humans, Lung, Predictive Value of Tests, Pulmonary Disease, Chronic Obstructive, Pulmonary Emphysema, Respiratory Function Tests, Risk Factors, Journal Article, Review