“Silent rival”: pharmacological correction of the pathology of small airways in asthma (focus on ciclesonide)

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Abstract

In real clinical practice, a controlled course of bronchial asthma is observed in hardly half of patients. Poorly controlled asthma reduces the quality of life and affects various aspects of human life, as well as increases the risk of disease exacerbations and hospitalizations. Reasons for poor asthma control may be related to the patient, medical care and asthma therapy. Small airway pathology may correlate with specific clinical features and poor disease control. Evidence from new studies suggests that exercise-induced symptoms, overweight/obesity, nocturnal symptoms, older age, smoking, T2 inflammation, and severe bronchial hyperresponsiveness are strong independent predictors of involvement of small airways in patients with asthma. The article describes the modern, most informative methods for assessing small airways dysfunction. These include spirometry, forced pulse oscillometry, single-breath or multiple-breath nitrogen washout test, body plethysmography, high-resolution computed tomography, exhaled nitric oxide assessment, and others. In general, as various studies show, the prevalence of small airways involvement in patients with BA is about 50–60%. The significant contribution of small airways to the pathophysiological mechanisms of bronchial obstruction and the clinical manifestations of asthma make the distal bronchial tree a reasonable target for pharmacological intervention. A new generation of inhalers that generate an extrafine particle drug aerosol (with a mass median aerodynamic particle size of less than 2 µm) at a slower nebulization rate and longer duration provides higher lung deposition rates and more efficient penetration of the aerosol into the small airways. The article presents data on the efficacy, some clinical benefits, safety of extrafine forms of inhaled glucocorticosteroids (such as ciclesonide) in the treatment of patients with asthma, including with the development of mild exacerbations.

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About the authors

Yulia G. Belotserkovskaya

Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: belo-yuliya@yandex.ru
ORCID iD: 0000-0003-1224-1904

Cand. Sci. (Med.), Associate Professor, Department of Pulmonology

Russian Federation, Moscow

A. I. Sinopalnikov

Russian Medical Academy of Continuous Professional Education

Email: belo-yuliya@yandex.ru
ORCID iD: 0000-0002-1990-2042
Russian Federation, Moscow

A. G. Romanovskikh

Russian Medical Academy of Continuous Professional Education

Email: belo-yuliya@yandex.ru
ORCID iD: 0000-0001-9675-7451
Russian Federation, Moscow

I. P. Smirnov

Russian Medical Academy of Continuous Professional Education

Email: belo-yuliya@yandex.ru
ORCID iD: 0000-0001-8954-5303
Russian Federation, Moscow

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