title: Targeting small airways in asthma: improvement in clinical benefit?
abstract: OBJECTIVE
  Disease control is not achieved in a substantial proportion of patients with asthma. Recent advances in aerosol formulations and delivery devices may offer more effective therapy. This review will focus on the importance and potential clinical benefit of targeting the lung periphery in adult asthma by means of ultra-fine aerosols.
  
  
  RESULTS
  Ultra-fine formulations of inhaled corticosteroids (ICS) have improved lung deposition up to at least 50%, primarily in the peripheral airways. Ultra-fine formulations of ICS provide equivalent asthma control to non-ultra-fine ICS at approximately half the daily dose, with no increased risk of systemic effects. Clinical studies of adults with asthma have shown a greater effect of ultra-fine ICS, compared with non-ultra-fine ICS, on quality of life, small airway patency, and markers of pulmonary and systemic inflammation, but no difference with regard to conventional clinical indices of lung function and asthma control.
  
  
  CONCLUSIONS
  Asthma patients treated with ultra-fine ICS, compared with non-ultra-fine ICS, have at least similar chance of achieving asthma control at a lower daily dose. Further clinical studies are needed to explore whether treatment with ultra-fine formulations of ICS will change the natural history of asthma and prevent airway remodelling in both the large and small airways.
authors.affiliation: Respiratory Section, Unit of Internal Medicine, Hvidovre University Hospital, Hvidovre, Denmark. csulrik@dadlnet.dk
authors.forename: Charlotte Suppli
authors.initials: CS
authors.lastname: Ulrik
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D000328:Adult; D000336:Aerosols / Q000009:adverse effects; D000402:Airway Obstruction / Q000517:prevention & control; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D015415:Biomarkers / Q000378:metabolism; D055745:Bronchioles / Q000187:drug effects* / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D008168:Lung / Q000187:drug effects / Q000503:physiopathology; D010316:Particle Size; D012123:Pulmonary Ventilation / Q000187:drug effects; D011788:Quality of Life; D018570:Risk Assessment
chemical_list: D000305:Adrenal Cortex Hormones; D000336:Aerosols; D018927:Anti-Asthmatic Agents; D015415:Biomarkers