Detecting Small Airways Dysfunction in Asthma: Rationale, Findings, and Future of ATLANTIS

Area of Science:

• Pulmonary Medicine
• Respiratory Research
• Asthma Diagnostics

Background:

• Small airway dysfunction (SAD) is prevalent and significant in asthma, yet lacks a definitive diagnostic standard.
• Current methods for identifying SAD in clinical practice are insufficient.

Purpose of the Study:

• To identify optimal biomarkers, physiological tests, and imaging markers for SAD detection in asthma.
• To evaluate SAD's impact on clinical asthma outcomes across all severity levels.
• To summarize key findings and future directions from the ATLANTIS study.

Main Methods:

• Prospective, multi-center, international observational study (ATLANTIS) with 1-year follow-up.
• Utilized a combination of spirometry, oscillometry, and a dedicated questionnaire.
• Statistical analysis included receiver operating characteristic (ROC) curve analysis and likelihood ratios.

Main Results:

• A 'toolbox' of spirometry, oscillometry, and a SAD questionnaire demonstrated high accuracy in detecting SAD (AUC 0.96, +LR 12.8).
• Oscillometry, in collaboration with other consortia, has shown utility in identifying distinct asthma phenotypes.
• SAD's contribution to clinical outcomes across asthma severities is being evaluated.

Conclusions:

• The ATLANTIS 'toolbox' offers a highly accurate method for identifying small airway dysfunction in asthma.
• This diagnostic approach holds potential for integration into future asthma research and clinical practice.
• Further validation is recommended before widespread adoption.