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Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and
Russell J Hopp1, Mark C Wilson2, M Asghar Pasha3
1Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, 68114, USA. rhopp@childrensomaha.org.
Insights
Small airway abnormalities are crucial in pediatric asthma, impacting lung function beyond large airways. This review highlights their role and potential treatments before biologics.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Pathophysiology
Background:
- Asthma affects all airway levels, with small airways constituting a significant portion of airflow.
- Current clinical focus often overemphasizes large airway obstruction, potentially underestimating small airway involvement in asthma.
- International guidelines, like the Global Initiative for Asthma (GINA), offer limited specific attention to small airway disease management.
Purpose of the Study:
- To review the role of small airway abnormalities in the pathogenesis and clinical expression of asthma in children.
- To synthesize existing literature on small airway disease in pediatric asthma.
- To explore potential pharmacological interventions for small airway dysfunction in pediatric asthma.
Main Methods:
- Comprehensive literature review focusing on adult and pediatric asthma studies.
- Analysis of data from various sources to enhance evaluation of small airway disease.
- Examination of standard diagnostic techniques, including spirometry, for small airway assessment.
Main Results:
- Evidence suggests small airway abnormalities play a significant role in asthma development and presentation.
- Standard diagnostic tools may underrepresent the impact of small airway disease.
- Pharmacological options for small airway dysfunction exist prior to advanced biologic therapies.
Conclusions:
- Small airway disease is an important, often underemphasized, component of pediatric asthma.
- Further research and clinical attention are needed to address small airway dysfunction in children with asthma.
- Exploring targeted pharmacological strategies for small airways may improve asthma management outcomes.
Abstract:
Asthma affects all portions of the airways. Small airways, however, comprise a substantial component of the conducting lung air flow. In asthma, inflammatory processes can affect the whole respiratory tract, from central to peripheral/small airways. The emphasis in adult and pediatric respiratory disease clinics is to focus on large airway obstruction and reversibility. This information, although valuable, underemphasizes a large portion of the conduction airway of asthmatics. Standard descriptions of asthma management focus on a multiple medication approaches. We particularly focused on the management of asthma in the international guidelines for the Global Initiative for Asthma (GINA). Overall, however, minimal attention is placed on the small airway pool in asthma medical management. We took the opportunity to thoroughly review and present specific data from the adult asthma literature which supported the concept that small airway abnormalities may play a role in the pathogenesis and clinical expression of asthma. Based on the conclusions of the adult asthma literature, we here present a thorough review of the literature as it relates to small airway disease in children with asthma. We used, collectively, individual data sources of data to expand the information available from standard diagnostic techniques, especially spirometry, in the evaluation of small airway disease. As the pharmacological approaches to moderate to severe asthma are advancing rapidly into the realm of biologics, we sought to present potential pharmacological options for small airway dysfunction in pediatrics prior to biological modifier intervention.
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