Alvesco

Patient profiles

The small airways are not a 'quiet zone', but actively contribute to asthma pathogenesis.1 As a result, therapies that are able to enter the small airways and reduce small airway inflammation, such as Alvesco®, may improve asthma control in a wide range of asthma patients.

Mild asthma

A seven-fold higher resistance in the small airways has been observed in mild asthma patients compared with normal subjects, even though their lung function measurements were within normal limits.2 Although it has a limited effect on pulmonary function, this increase in small airway resistance may contribute to increased airway responsiveness in asthma (Figure 1).


4 fig 1_Mild asthma

Figure 1: Increased peripheral resistance in patients with mild asthma. Adapted from Wagner et al., 19903

Allergic asthma

Small-size aeroallergens (Table 1) are fine enough to reach the smallest parts of the airways and trigger asthma at these sites.4,5 Therefore, treating the small airways of patients with allergic asthma may help to tackle inflammation in this region.

4 table 1_Allegic asthma

Table 1: Fine particle aeroallergens can enter the smallest airways

Severe asthma

An increased closing volume (CV)/vital capacity (VC) ratio, detected by the single-breath nitrogen washout test, is indicative of small airway disease. In severe asthma, these increases are associated with recurrent asthma exacerbations (Figure 2).7

4 fig 2_Severe asthma
FEV1: forced expiratory volume in one second; RV: residual volume

Figure 2: CV/VC ratio is significantly higher in patients with severe asthma.7 
Reproduced with permission of the American Thoracic Society. Copyright© 2015 American Thoracic Society.

Nocturnal asthma

Increased alveolar tissue inflammation observed at night is indicative of small airway inflammation and has been observed in patients with nocturnal asthma (Figure 3).8,9

 
4 fig 3_Nocturnal asthma
 Figure 3: Increased peripheral resistance at night in asthma patients with nocturnal asthma.8 
Reproduced with permission of the American Thoracic Society. Copyright© 2015 American Thoracic Society.

Exercise-induced asthma

The small airways of patients with exercise-induced asthma are responsive to cool, dry air, which suggests that they play an important role in asthma in this patient population.10

4 fig 4_Exercise-induced asthma
Figure 4: Cool, dry air stimulation increases peripheral lung resistance in patients with mild asthma. Adapted from Kaminsky DA, et al 1995.10

Read about how to use the Alvesco® inhaler correctly and how to choose the right inhaler for your patients.

References
  1. Contoli M, Bousquet J, Fabbri LM, et al. The small airways and distal lung compartment in asthma and COPD: a time for reappraisal. Allergy 2010;65:141-51.
  2. Wagner EM, Liu MC, Weinmann GG, et al. Peripheral lung resistance in normal and asthmatic subjects. Am Rev Respir Dis 1990;141:584-8.
  3. Zeldin DC, Eggleston P, Chapman M, et al. How exposures to biologics influence the induction and incidence of asthma. Environ Health Perspect 2006;114:620-6.
  4. Bacsi A, Choudhury BK, Dharajiya N, et al. Subpollen particles: carriers of allergenic proteins and oxidases. J Allergy Clin Immunol 2006;118:844-50.
  5. Erwin EA, Woodfolk JA, Custis N, et al. Animal danders. Immunol Allergy Clin North Am 2003;23:469-81.
  6. Zeidler MR, Goldin JG, Kleerup EC, et al. Small airways response to naturalistic cat allergen exposure in subjects with asthma. J Allergy Clin Immunol 2006;118:1075-81.
  7. in 't Veen JC, Beekman AJ, Bel EH, et al. Recurrent exacerbations in severe asthma are associated with enhanced airway closure during stable episodes. Am J Respir Crit Care Med 2000;161:1902-6.
  8. Kraft M, Pak J, Martin RJ, et al. Distal lung dysfunction at night in nocturnal asthma. Am J Respir Crit Care Med 2001;163:1551-6.
  9. Kraft M, Djukanovic R, Wilson S, et al. Alveolar tissue inflammation in asthma. Am J Respir Crit Care Med 1996;154:1505-10.
  10. Kaminsky DA, Irvin CG, Gurka DA, et al. Peripheral airways responsiveness to cool, dry air in normal and asthmatic individuals. Am J Respir Crit Care Med 1995;152:1784-90.

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