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Dilemmas, confusion, and misconceptions related to small airways directed therapy

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Title: Dilemmas, confusion, and misconceptions related to small airways directed therapy
Authors: Usmani, OS
Item Type: Journal Article
Abstract: Over the last decade, there is increasing evidence that the small airways, i. e. airways <2 mm in internal diameter, contribute significantly to the pathophysiology and clinical expression of asthma and chronic obstructive pulmonary disease (COPD). The increased interest in small airways is, at least in part, a result of innovation in small-particle aerosol formulations that better target the distal lung and also advanced physiological methods of assessing small airway responses. Increasing the precision of drug deposition may improve targeting of specific diseases or receptor locations, decrease airway drug exposure and side effects, and thereby increase the efficiency and effectiveness of inhaled drug delivery. The availability of small-particle aerosols of corticosteroid, bronchodilator or their combination, enables a higher total lung deposition, better peripheral lung penetration, and provides added clinical benefit, compared to large-particle aerosol treatment. However, a number of questions remain unanswered on the pragmatic approach relevant in order for clinicians to consider the role of small airways directed therapy in the day-to-day management of their patients with asthma and COPD. We have thus tried to clarify the dilemmas, confusion, and misconceptions related to small airways directed therapy. To this end, we have systematically reviewed all studies on small-particle aerosol therapy in order to address the dilemmas, confusion, and misconceptions related to small airways directed therapy.
Issue Date: 11-Aug-2016
Date of Acceptance: 30-Jul-2016
URI: http://hdl.handle.net/10044/1/38614
DOI: https://dx.doi.org/10.1016/j.chest.2016.07.035
ISSN: 1931-3543
Publisher: Elsevier
Start Page: 1345
End Page: 1355
Journal / Book Title: Chest
Volume: 151
Issue: 6
Copyright Statement: © 2016 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
Respiratory System
General & Internal Medicine
aerosols
asthma
COPD
inhalers
small airways
small particles
DRY POWDER INHALER
DIPROPIONATE EXTRAFINE AEROSOL
OBSTRUCTIVE PULMONARY-DISEASE
ALVEOLAR NITRIC-OXIDE
METERED-DOSE INHALER
HIGH LUNG DEPOSITION
BECLOMETHASONE DIPROPIONATE
HYDROFLUOROALKANE-134A BECLOMETHASONE
PARTICLE-SIZE
FLUTICASONE PROPIONATE
Administration, Inhalation
Asthma
Beclomethasone
Bronchioles
Bronchodilator Agents
Disease Management
Drug Combinations
Dry Powder Inhalers
Equipment Design
Fluocinolone Acetonide
Formoterol Fumarate
Glucocorticoids
Humans
Inhalation Spacers
Metered Dose Inhalers
Nebulizers and Vaporizers
Particle Size
Pregnenediones
Pressure
Pulmonary Disease, Chronic Obstructive
Aerosol Drug Management Improvement Team (ADMIT)
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Airway Disease
Faculty of Medicine



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