Small Airway Targeted Therapy in Pediatric Asthma: Are We There Yet?

The short answer is: no. Targeting small airways (less than 2 mm in diameter) in the management of asthma has received more attention recently. Clinicians need to be aware of small airway inflammation especially in patients with severe or nocturnal asthma.

Increased resistance of small airways may be assessed noninvasively by spirometry, nitrogen wash out, body plethysmography, impulse oscillometry (IOS), and using imaging (high resolution computed tomography or conventional chest X-ray).

The use of metered-dose inhaler (MDI) products with extrafine particles of inhaled corticosteroids has been suggested for targeted therapy of small airways. However, studies in pediatrics have generally been inconclusive.

References:

Small Airway Targeted Therapy in Pediatric Asthma: Are We There Yet? Hengameh H. Raissy, PharmD and Kathryn Blake. Pediatr Allergy Immunol Pulmonol. 2013 December 1; 26(4): 204–206.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869414

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