Assessing and accessing the small airways; implications for asthma management

Nicola Scichilone, Marco Contoli, Davide Paleari, Pietro Pirina, Andrea Rossi, Claudio Maria Sanguinetti, Pierachille Santus, Matteo Sofia, Nicola Sverzellati

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Despite the wealth of experience in the management of asthma, the disease remains inadequately controlled in some patients, who face long-term respiratory impairment and disability. The disease has been characterised as an inflammatory condition affecting first the larger airways and eventually the smaller airways, but there is evidence that peripheral airway involvement defines a particular and more severe phenotype of asthma. For this reason, assessing functional and biological parameters reflective of small airways involvement is important prognostically. No assessment method is universally and directly representative of peripheral airway function, but the traditional spirometric tests, including vital capacity, residual volume and forced vital capacity, are somewhat correlated with this function; useful methods for further assessment include the single-breath nitrogen wash-out test, impulse oscillometry, nitrous oxide and exhaled breath concentrate measurements, as well as computed tomography to reflect air trapping and response to treatment. Formulation advancements have made for easier treatment access to the smaller airways, with the new extrafine formulations resulting in better asthma control compared with non-extrafine formulations.

Original languageEnglish (US)
Pages (from-to)172-179
Number of pages8
JournalPulmonary Pharmacology and Therapeutics
Issue number2
StatePublished - Apr 2013
Externally publishedYes


  • Asthma
  • Extrafine
  • Imaging
  • Inflammation
  • Peripheral airways
  • Small airways

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Biochemistry, medical
  • Pharmacology (medical)


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