Abstract
Small airways dysfunction (SAD) in adults with persistent asthma and preserved forced expiratory volume in 1 second (FEV1) is related to worse asthma control. [1] Manoharan A Anderson WJ Lipworth J Ibrahim I Lipworth BJ Small airway dysfunction is associated with poorer asthma control. Eur Respir J. 2014; 44: 1353-1355 Crossref PubMed Scopus (46) Google Scholar Impulse oscillometry (IOS) is an effort-independent test used to phenotype SAD, which involves normal quiet tidal breathing. [2] Galant SP Komarow HD Shin HW Siddiqui S Lipworth BJ The case for impulse oscillometry in the management of asthma in children and adults. Ann Allergy Asthma Immunol. 2017; 118: 664-671 Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar Peripheral airways resistance can be derived from the difference between resistance at 5 Hz and 20 Hz (R5-R20), whereas the area under the reactance curve (AX) reflects peripheral lung compliance. [3] Lipworth B Manoharan A Anderson W Unlocking the quiet zone: the small airway asthma phenotype. Lancet Respir Med. 2014; 2: 497-506 Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar In patients with moderate to severe persistent asthma, R5-R20 and AX, but not spirometry, were closely related to asthma control, as assessed by the Asthma Control Questionnaire (ACQ). [4] Jabbal S Manoharan A Lipworth J Lipworth B Utility of impulse oscillometry in patients with moderate to severe persistent asthma. J Allergy Clin Immunol. 2016; 138: 601-603 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Type 2 inflammation plays a central role in asthma disease pathophysiology by determining downstream airway hyperresponsiveness and remodeling. Widely used clinical type 2 airway inflammatory biomarkers (T2) include fractional exhaled nitric oxide (FeNO), serum immunoglobulin E (IgE), and blood eosinophils (Eos). [5] Robinson D Humbert M Buhl R et al. Revisiting Type 2-high and Type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy. 2017; 47: 161-175 Crossref PubMed Scopus (247) Google Scholar
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