Do small airway abnormalities characterize asthma phenotypes? In search of proof

M. Contoli, M. Kraft, Q. Hamid, J. Bousquet, K. F. Rabe, L. M. Fabbri, A. Papi

Research output: Contribution to journalReview articlepeer-review

49 Scopus citations


Summary: The role of small airway abnormalities in asthma pathogenesis has been extensively studied and debated for several decades. However, whether or not small airway abnormalities play a relevant role in specific phenotypes of asthmatic patients and contribute to clinical presentation is largely unknown. In the present review, we evaluated available data on the role of small airways in severe asthma, with a further focus on asthma in smokers and asthma in the elderly. These phenotypes are characterized by a poor response to treatment and they can represent a model of greater small airway impairment. In severe asthmatics, small airway involvement has been shown through evidence of both distal inflammation and of increased air trapping. The few available data on asthmatics who smoke, and elderly asthmatics, similarly suggests that small airway abnormalities contribute to the pathogenesis of the disease. In this perspective, there could be a rationale for specifically assessing small airway impairment in these patients and for clinical studies evaluating whether pharmacological approaches targeting the more peripheral airways result in clinical benefits beyond conventional therapy.

Original languageEnglish (US)
Pages (from-to)1150-1160
Number of pages11
JournalClinical and Experimental Allergy
Issue number8
StatePublished - Aug 2012


  • Asthma
  • Inflammation
  • Phenotypes
  • Small airways

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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