Can measures of small airway dysfunction aid with the diagnosis or management of asthma exacerbations? A systematic review.

IF 3.6 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2025-06-26 DOI:10.1136/bmjresp-2024-002926

Abdulrahman Alshehri, Mohammed Ibrahim Alshahrani, Elizabeth Sapey, Robert Andrew Stockley, Mohammed Almeshari

{"title":"Can measures of small airway dysfunction aid with the diagnosis or management of asthma exacerbations? A systematic review.","authors":"Abdulrahman Alshehri, Mohammed Ibrahim Alshahrani, Elizabeth Sapey, Robert Andrew Stockley, Mohammed Almeshari","doi":"10.1136/bmjresp-2024-002926","DOIUrl":null,"url":null,"abstract":"Background: Asthma exacerbations are acute episodes with worsened symptoms and decreased lung function. Current diagnosis relies on clinical assessment and spirometry, lacking a gold standard test. Interest in small airways tests suggests they may identify treatable traits. This review examines evidence for using small airways tests in diagnosing and managing exacerbations.Methods: The protocol was prospectively registered on PROSPERO, and the systematic review followed standard methodology. Multiple electronic databases were searched, including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCOhost) and Cochrane Central Register of Controlled Trials (Cochrane Library). The search strategy combined subject headings and keywords related to asthma exacerbations and small airway function tests. Observational studies and randomised controlled trials (RCTs) assessing these tests for detecting or monitoring exacerbations in adults (≥18 years) were included, without language or date restrictions. Risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias 2 tool for RCTs.Results: Seven studies (six observational, one RCT) met the inclusion criteria. Five included forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75), also referred to as maximal mid-expiratory flow; one used isolated forced expiratory flow measures (FEF25, FEF50 and FEF75); and one included multiple breath washout (MBW). No study specifically tested whether small airway function tests improved the diagnosis or monitoring of exacerbations. However, all showed worsening small airway measures during exacerbations, which improved on recovery. FEF25-75 showed greater percentage change than forced expiratory volume in one second postrecovery. The MBW study reported increased acinar ventilation heterogeneity (Sacin) and conductive ventilation heterogeneity (Scond), suggesting small airway involvement.Conclusion: Conducting physiological tests for small airway function appears feasible during an exacerbation. These tests may have utility in the diagnosis or monitoring of acute asthma exacerbations. However, existing studies are heterogeneous and further research is needed.Prospero registration number: CRD42024494994.","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Respiratory Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjresp-2024-002926","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Asthma exacerbations are acute episodes with worsened symptoms and decreased lung function. Current diagnosis relies on clinical assessment and spirometry, lacking a gold standard test. Interest in small airways tests suggests they may identify treatable traits. This review examines evidence for using small airways tests in diagnosing and managing exacerbations.

Methods: The protocol was prospectively registered on PROSPERO, and the systematic review followed standard methodology. Multiple electronic databases were searched, including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCOhost) and Cochrane Central Register of Controlled Trials (Cochrane Library). The search strategy combined subject headings and keywords related to asthma exacerbations and small airway function tests. Observational studies and randomised controlled trials (RCTs) assessing these tests for detecting or monitoring exacerbations in adults (≥18 years) were included, without language or date restrictions. Risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias 2 tool for RCTs.

Results: Seven studies (six observational, one RCT) met the inclusion criteria. Five included forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75), also referred to as maximal mid-expiratory flow; one used isolated forced expiratory flow measures (FEF25, FEF50 and FEF75); and one included multiple breath washout (MBW). No study specifically tested whether small airway function tests improved the diagnosis or monitoring of exacerbations. However, all showed worsening small airway measures during exacerbations, which improved on recovery. FEF25-75 showed greater percentage change than forced expiratory volume in one second postrecovery. The MBW study reported increased acinar ventilation heterogeneity (Sacin) and conductive ventilation heterogeneity (Scond), suggesting small airway involvement.

Conclusion: Conducting physiological tests for small airway function appears feasible during an exacerbation. These tests may have utility in the diagnosis or monitoring of acute asthma exacerbations. However, existing studies are heterogeneous and further research is needed.

Prospero registration number: CRD42024494994.

查看原文本刊更多论文

小气道功能障碍的测量是否有助于哮喘发作的诊断或治疗？系统回顾。

背景：哮喘急性发作是伴随症状恶化和肺功能下降的急性发作。目前的诊断依赖于临床评估和肺活量测定，缺乏金标准测试。对小气道测试的兴趣表明，它们可以识别出可治疗的特征。本综述探讨了使用小气道试验诊断和处理急性加重的证据。方法：该方案在PROSPERO上前瞻性注册，系统评价遵循标准方法学。检索多个电子数据库，包括MEDLINE （Ovid）、EMBASE （Ovid）、CINAHL （EBSCOhost）和Cochrane Central Register of Controlled Trials （Cochrane Library）。搜索策略结合了与哮喘恶化和小气道功能测试相关的主题标题和关键词。纳入观察性研究和随机对照试验（rct），评估这些检测或监测成人（≥18岁）恶化的试验，没有语言或日期限制。观察性研究使用纽卡斯尔-渥太华量表（NOS）评估偏倚风险，随机对照试验使用Cochrane偏倚风险2工具评估偏倚风险。结果：7项研究（6项观察性研究，1项RCT）符合纳入标准。其中5项包括用力呼气流量在用力肺活量（FEF25-75）的25%至75%之间，也称为最大呼气中流量；一组采用孤立用力呼气流量测量（FEF25、FEF50和FEF75）；其中一项包括多次呼气冲洗（MBW）。没有研究专门测试小气道功能测试是否能改善病情恶化的诊断或监测。然而，所有患者在加重期间均显示小气道测量恶化，恢复后有所改善。恢复后1秒内FEF25-75比用力呼气量变化更大。MBW研究报告了腺泡通气异质性（Sacin）和传导通气异质性（second）的增加，表明小气道受损伤。结论：在急性发作期间进行小气道功能生理检查是可行的。这些试验可用于诊断或监测急性哮喘发作。然而，现有的研究是异质的，需要进一步的研究。普洛斯彼罗注册号：CRD42024494994。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

期刊介绍： BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.