Vía aérea pequeña: de la definición al tratamiento

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Vía aérea pequeña
resistencia al flujo aéreo
asma
EPOC

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Vía aérea pequeña: de la definición al tratamiento. (2023). Revista Alergia México, 70(1), 22-37. https://doi.org/10.29262/ram.v70i1.1190 (Original work published 2023)

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La vía aérea pequeña, presente desde los orígenes de la humanidad y descrita hace apenas un siglo, se ha descubierto recientemente como el sitio anatómico donde inicia la inflamación provocada por algunas enfermedades pulmonares obstructivas: asma y enfermedad pulmonar obstructiva crónica (EPOC), per se. Se ha identificado disfunción de la vía aérea pequeña en el 91% de los pacientes asmáticos y en una gran proporción de quienes padecen EPOC. En los pacientes sin enfermedad, la vía aérea pequeña representa el 98.8% (4500 mL) del volumen pulmonar total, y solo aporta del 10 al 25% de la resistencia pulmonar total; sin embargo, en sujetos con obstrucción puede suponer el 90% de la resistencia total. A pesar de esto, sus características morfológicas y funcionales permiten que la disfunción pase inadvertida por métodos diagnósticos convencionales, por ejemplo la espirometría. Con base en lo anterior, el objetivo de este estudio fue revisar el panorama general de los métodos disponibles para evaluar la vía aérea pequeña y los posibles tratamientos asociados con esta zona silente.

Palabras clave: Vía aérea pequeña; resistencia al flujo aéreo; asma; EPOC.

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West JB. Fritz Rohrer (1888–1926), a pioneer in pulmonary mechanics whose work was inexplicably ignored for about 30 years. Am J Physiol Lung Cell Mol Physiol. 2019 Dec 1;317(6):L785-L790. doi: 10.1152/ajplung.00250.2019. Epub 2019 Oct 2. PMID: 31577160.

Mitzner W. Mechanics of the lung in the 20th century. Compr Physiol. 2011 Oct;1(4):2009-27. doi: 10.1002/cphy.c100067. PMID: 23733695; PMCID: PMC4562454.

Hopp RJ, Wilson MC, Pasha MA. Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and Commentary. Clin Rev Allergy Immunol. 2022 Feb;62(1):145-159. doi: 10.1007/s12016-020-08818-1. Epub 2020 Nov 26. PMID: 33241492.

Carr TF, Altisheh R, Zitt M. Small airways disease and severe asthma. World Allergy Organ J. 2017 Jun 21;10(1):20. doi: 10.1186/s40413-017-0153-4. PMID: 28649293; PMCID: PMC5479008.

Levitzky MG, Pulmonary Physiology, 9e, New York: McGraw-Hill, 2013.

McNulty W, Usmani OS. Techniques of assessing small airways dysfunction. Eur Clin Respir J. 2014 Oct 17;1. doi: 10.3402/ecrj.v1.25898. PMID: 26557240; PMCID: PMC4629724.

M. H. Ross and W. Pawlina, Histology: A Text and Atlas with Correlated Cell and Molecular Biology, 7e, New York: Wolters Kluwer Health, 2016.

Bonini M, Usmani OS. The role of the small airways in the pathophysiology of asthma and chronic obstructive pulmonary disease. Ther Adv Respir Dis. 2015 Dec;9(6):281-93

Cazzola M, Calzetta L, Matera MG. Long-acting muscarinic antagonists and small airways in asthma: Which link? Allergy. 2021 Jul;76(7):1990-2001. doi: 10.1111/all.14766. Epub 2021 Feb 27. PMID: 33559139.

Quinton PM. Both Ways at Once: Keeping Small Airways Clean. Physiology (Bethesda). 2017 Sep;32(5):380-390. doi: 10.1152/physiol.00013.2017. PMID: 28814498.

Jain M, Sznajder JI. Bench-to-bedside review: distal airways in acute respiratory distress syndrome. Crit Care. 2007;11(1):206. doi: 10.1186/cc5159. PMID: 17306039; PMCID: PMC2151900.

Adcock IM, Gilbey T, Gelder CM, Chung KF, Barnes PJ. Glucocorticoid receptor localization in normal and asthmatic lung. Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):771-82. doi: 10.1164/ajrccm.154.3.8810618. PMID: 8810618.

Barnes, P., Basbaum, C., Nadel, J. et al. Localization of β-adrenoreceptors in mammalian lung by light microscopic autoradiography. Nature. 1982 Sep 30;299(5882):444-7. doi: 10.1038/299444a0. PMID: 6289123.

Stewart JI, Criner GJ. The small airways in chronic obstructive pulmonary disease: pathology and effects on disease progression and survival. Curr Opin Pulm Med. 2013 Mar;19(2):109-15. doi: 10.1097/MCP.0b013e32835ceefc. PMID: 23325030.

Ikeda T, Anisuzzaman AS, Yoshiki H, Sasaki M, Koshiji T, Uwada J, Nishimune A, Itoh H, Muramatsu I. Regional quantification of muscarinic acetylcholine receptors and β-adrenoceptors in human airways. Br J Pharmacol. 2012 Jul;166(6):1804-14. doi: 10.1111/j.1476-5381.2012.01881.x. PMID: 22300233; PMCID: PMC3402805.

Hogg JC. Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet. 2004 Aug 21-27;364(9435):709-21. doi: 10.1016/S0140-6736(04)16900-6. PMID: 15325838.

Schittny JC. Development of the lung. Cell Tissue Res. 2017 Mar;367(3):427-444. doi: 10.1007/s00441-016-2545-0. Epub 2017 Jan 31. PMID: 28144783; PMCID: PMC5320013.

Global Initiative for Asthma., Global Strategy for Asthma Management and Prevention, 2021. https://ginasthma.org/gina-reports/

Hamid Q. Pathogenesis of small airways in asthma. Respiration. 2012;84(1):4-11. doi: 10.1159/000339550. Epub 2012 Jun 29. PMID: 22759947.

Hamid Q, Song Y, Kotsimbos TC, Minshall E, Bai TR, Hegele RG, Hogg JC. Inflammation of small airways in asthma. J Allergy Clin Immunol. 1997 Jul;100(1):44-51. doi: 10.1016/s0091-6749(97)70193-3. PMID: 9257786.

M. Synek, R. Beasley, A. J. Frew, J. Goulding, L. Holloway, F. C. Lampe, W. R. Roche and S. T. Holgate. Cellular infiltration of the airways in asthma of varying severity. Am J Respir Crit Care Med. 1996 Jul;154(1):224-30. doi: 10.1164/ajrccm.154.1.8680684. PMID: 8680684.

M. de Medeiros Matsushita, L. F. Ferraz da Silva, M. A. dos Santos , S. Fernezlian, J. Schrumpf, P. Roughley, P. Hiemstra, P. H. Nascimento Saldiva, T. Mauad and M. Dolhnikoff. Airway proteoglycans are differentially altered in fatal asthma. J Pathol. 2005 Sep;207(1):102-10. doi: 10.1002/path.1818. PMID: 16041692.

Q. A. Hamid.Peripheral inflammation is more important than central inflammation. Respir Med. 1997 Nov;91 Suppl A:11-2. doi: 10.1016/s0954-6111(97)90098-6. PMID: 9474360.

Fehrenbach H, Wagner C, Wegmann M. Airway remodeling in asthma: what really matters. Cell Tissue Res. 2017 Mar;367(3):551-569. doi: 10.1007/s00441-016-2566-8. Epub 2017 Feb 11. PMID: 28190087; PMCID: PMC5320023.

D. S. Postma, C. Brightling, S. Baldi, M. Van den Berge, L. M. Fabbri, A. Gagnatelli, A. Papi, T. Van der Molen, K. F. Rabe, S. Siddiqui, D. Singh, G. Nicolini and M. Kraft.Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study. Lancet Respir Med. 2019 May;7(5):402-416. doi: 10.1016/S2213-2600(19)30049-9. Epub 2019 Mar 12. Erratum in: Lancet Respir Med. 2019 Sep;7(9):e28. PMID: 30876830.

J. C. in 't Veen, A. J. Beekman, E. H. Bel and P. J. Sterk.Recurrent exacerbations in severe asthma are associated with enhanced airway closure during stable episodes. Am J Respir Crit Care Med. 2000 Jun;161(6):1902-6. doi: 10.1164/ajrccm.161.6.9906075. PMID: 10852764.

P. T. Macklem and J. Mead.Resistance of central and peripheral airways measured by a retrograde catheter. J Appl Physiol. 1967 Mar;22(3):395-401. doi: 10.1152/jappl.1967.22.3.395. PMID: 4960137.

J. H. Bates and B. Suki .Assessment of peripheral lung mechanics. Respir Physiol Neurobiol. 2008 Nov 30;163(1-3):54-63. doi: 10.1016/j.resp.2008.03.012. Epub 2008 Apr 1. PMID: 18463006; PMCID: PMC2644217.

S. Battaglia, H. den Hertog, M. C. Timmers, S. Lazeroms, A. Vignola, K. Rabe, V. Bellia, P. Hiemstra and P. Sterk.Small airways function and molecular markers in exhaled air in mild asthma. Thorax. 2005 Aug;60(8):639-44. doi: 10.1136/thx.2004.035279. PMID: 16061704; PMCID: PMC1747499.

B. Lipworth, A. Manoharan and W. Anderson.Unlocking the quiet zone: the small airway asthma phenotype. Lancet Respir Med. 2014 Jun;2(6):497-506. doi: 10.1016/S2213-2600(14)70103-1. PMID: 24899370.

B. Delcasso, J. M. Dot, J. M. Peloni and G. Devouassoux.Phenotypic characteristics of asthma with small airways involvement. European Respiratory Journal Sep 2016, 48 (suppl 60) PA5009; DOI: 10.1183/13993003.congress-2016.PA5009

GOLD, Global Initiative Chronic Obstructive Lung Disease, 2022. https://goldcopd.org/2022-gold-reports-2/

M. G. Cosio, K. A. Hale, D. E. Niewoehner, M. Markert.Morphologic and Morphometric Effects of Prolonged Cigarette Smoking on the Small Airways. Am Rev Respir Dis. 1980 Aug;122(2):265-21. doi: 10.1164/arrd.1980.122.2.265. PMID: 7416603.

Singh, D., Long, G., Cançado, J. E. D., & Higham, A. Small airway disease in chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2020 Mar;26(2):162-168. doi: 10.1097/MCP.0000000000000637. PMID: 31688242.

D. M. Vasilescu, et al. Noninvasive Imaging Biomarker Identifies Small Airway Damage in Severe Chronic Obstructive Pulmonary Disease Am J Respir Crit Care Med. 2019 Sep 1;200(5):575-581. doi: 10.1164/rccm.201811-2083OC. PMID: 30794432; PMCID: PMC6727153.

Eapen, M. S., Hansbro, P. M., McAlinden, K., Kim, R. Y., Ward, C., Hackett, T.-L., Walters, E. H., & Sohal, S. S.Abnormal M1/M2 macrophage phenotype profiles in the small airway wall and lumen in smokers and chronic obstructive pulmonary disease. Sci Rep. 2017 Oct 17;7(1):13392. doi: 10.1038/s41598-017-13888-x. PMID: 29042607; PMCID: PMC5645352.

Tanabe, N., Shima, H., Sato, S., Oguma, T., Kubo, T., Kozawa, S., Koizumi, K., Sato, A., Togashi, K., & Hirai, T. Direct evaluation of peripheral airways using ultra-high-resolution CT in chronic obstructive pulmonary disease. Eur J Radiol. 2019 Nov;120:108687. doi: 10.1016/j.ejrad.2019.108687. Epub 2019 Sep 20. PMID: 31574362.

Su, Z.-Q., Guan, W.-J., Li, S.-Y., Ding, M., Chen, Y., Jiang, M., Chen, X.-B., Zhong, C.-H., Tang, C.-L., & Zhong, N.-S. Significances of spirometry and impulse oscillometry for detecting small airway disorders assessed with endobronchial optical coherence tomography in COPD. Int J Chron Obstruct Pulmon Dis. 2018 Oct 1;13:3031-3044. doi: 10.2147/COPD.S172639. PMID: 30319251; PMCID: PMC6171757.

Gennimata, S.-A., Palamidas, A., Karakontaki, F., Kosmas, E. N., Koutsoukou, A., Loukides, S., & Koulouris, N. G. Pathophysiology of Evolution of Small Airways Disease to Overt COPD. COPD. 2010 Aug;7(4):269-75. doi: 10.3109/15412555.2010.497515. PMID: 20673036.

Crisafulli, E., Pisi, R., Aiello, M., Vigna, M., Tzani, P., Torres, A., Bertorelli, G., & Chetta, A.Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease. Respiration. 2017;93(1):32-41. doi: 10.1159/000452479. Epub 2016 Nov 17. PMID: 27852080.

Contoli, M., Bousquet, J., Fabbri, L. M., Magnussen, H., Rabe, K. F., Siafakas, N. M., Hamid, Q., & Kraft, M. The small airways and distal lung compartment in asthma and COPD: a time for reappraisal. Allergy. 2010 Feb;65(2):141-51. doi: 10.1111/j.1398-9995.2009.02242.x. Epub 2009 Nov 11. PMID: 19909298.

Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, Hallstrand TS, Kaminsky DA, McCarthy K, McCormack MC, Oropez CE, Rosenfeld M, Stanojevic S, Swanney MP, Thompson BR. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019 Oct 15;200(8):e70-e88. doi: 10.1164/rccm.201908-1590ST. PMID: 31613151; PMCID: PMC6794117

Silva-Cerón M, Gochicoa-Rangel L, Benítez-Pérez. Manual de procedimiento de espirometría forzada del Laboratorio de Función Pulmonar. México: INER. Observaciones no publicadas

Huprikar NA, Skabelund AJ, Bedsole VG, Sjulin TJ, Karandikar AV, Aden JK, Morris MJ. Comparison of Forced and Slow Vital Capacity Maneuvers in Defining Airway Obstruction. Respir Care. 2019 Jul;64(7):786-792. doi: 10.4187/respcare.06419. Epub 2019 Mar 19. PMID: 30890630

R. E. Benítez-Pérez, L T. Bouscoulet, N. V. Alá,* R. F Del-Río-Hidalgo, R. Pérez-Padilla, J. C. Vázquez-García, M. Silva-Cerón, S. Cid-Juárez, L. Gochicoa-Rangel.Espirometría: recomendaciones y procedimiento,” Neumol Cir Torax. 2016;75(2):173-190. doi:10.35366/67124.

Deepak D, Prasad A, Atwal SS, Agarwal K. Recognition of Small Airways Obstruction in Asthma and COPD - The Road Less Travelled. J Clin Diagn Res. 2017 Mar;11(3):TE01-TE05. doi: 10.7860/JCDR/2017/19920.9478. Epub 2017 Mar 1. PMID: 28511478; PMCID: PMC5427404.

Konstantinos Katsoulis K, Kostikas K, Kontakiotis T. Techniques for assessing small airways function: Possible applications in asthma and COPD. Respir Med. 2016 Oct;119:e2-e9. doi: 10.1016/j.rmed.2013.05.003. Epub 2013 Jun 10. PMID: 23764129.

Quanjer PH, Pretto JJ, Brazzale DJ, Boros PW. Grading the severity of airways obstruction: new wine in new bottles. Eur Respir J. 2014 Feb;43(2):505-12. doi: 10.1183/09031936.00086313. Epub 2013 Aug 29. PMID: 23988764.

Usmani OS, Singh D, Spinola M, Bizzi A, Barnes PJ. The prevalence of small airways disease in adult asthma: A systematic literature review. Respir Med. 2016 Jul;116:19-27. doi: 10.1016/j.rmed.2016.05.006. Epub 2016 May 7. PMID: 27296816.

Criée CP, Sorichter S, Smith HJ, Kardos P, Merget R, Heise D, Berdel D, Köhler D, Magnussen H, Marek W, Mitfessel H, Rasche K, Rolke M, Worth H, Jörres RA; Working Group for Body Plethysmography of the German Society for Pneumology and Respiratory Care. Body plethysmography--its principles and clinical use. Respir Med. 2011 Jul;105(7):959-71. doi: 10.1016/j.rmed.2011.02.006. Epub 2011 Feb 26. PMID: 21356587.

Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Aliverti A, Barjaktarevic I, Cooper BG, Culver B, Derom E, Hall GL, Hallstrand TS, Leuppi JD, MacIntyre N, McCormack M, Rosenfeld M, Swenson ER. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022 Jul 13;60(1):2101499. doi: 10.1183/13993003.01499-2021. PMID: 34949706.

Casanova C, Cote C, de Torres JP, Aguirre-Jaime A, Marin JM, Pinto-Plata V, Celli BR. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005 Mar 15;171(6):591-7. doi: 10.1164/rccm.200407-867OC. Epub 2004 Dec 10. PMID: 15591470.

Oppenheimer BW, Goldring RM, Herberg ME, Hofer IS, Reyfman PA, Liautaud S, Rom WN, Reibman J, Berger KI. Distal airway function in symptomatic subjects with normal spirometry following World Trade Center dust exposure. Chest. 2007 Oct;132(4):1275-82. doi: 10.1378/chest.07-0913. Epub 2007 Sep 21. PMID: 17890470.

Desai U, Joshi JM. Impulse oscillometry. Adv Respir Med. 2019;87(4):235-238. doi: 10.5603/ARM.a2019.0039. PMID: 31476011.

Williamson PA, Clearie K, Menzies D, Vaidyanathan S, Lipworth BJ. Assessment of small-airways disease using alveolar nitric oxide and impulse oscillometry in asthma and COPD. Lung. 2011 Apr;189(2):121-9. doi: 10.1007/s00408-010-9275-y. Epub 2010 Dec 22. PMID: 21174112.

Gochicoa-Rangel, L., Cantú-González, G., Miguel-Reyes, J. L., Rodríguez-Moreno, L., & Torre-Bouscoulet, L., “ Oscilometría de impulso. Recomendaciones y procedimiento.,” NCT Neumología y Cirugía de Tórax, 2019. doi: 10.35366/NTS192E.

Yamaguchi, K., Tsuji, T., Aoshiba, K., Nakamura, H., & Abe, S. Anatomical backgrounds on gas exchange parameters in the lung World Journal of Respirology, 2019. DOI:10.5320/wjr.v9.i2.8

F. J. Al-Bazzaz, “Single-Breath Nitrogen Washout.,” Chest, 1979. doi: 10.1378/chest.76.1.83

Robinson PD, Latzin P, Verbanck S, Hall GL, Horsley A, Gappa M, Thamrin C, Arets HG, Aurora P, Fuchs SI, King GG, Lum S, Macleod K, Paiva M, Pillow JJ, Ranganathan S, Ratjen F, Singer F, Sonnappa S, Stocks J, Subbarao P, Thompson BR, Gustafsson PM. Consensus statement for inert gas washout measurement using multiple- and single- breath tests. Eur Respir J. 2013 Mar;41(3):507-22. doi: 10.1183/09031936.00069712. Epub 2013 Feb 8. Erratum in: Eur Respir J. 2013 Nov;42(5):1432. Ranganathan, Sarah [corrected to Ranganathan, Sarath]. PMID: 23397305.

Verbanck SAB, Polfliet M, Schuermans D, Ilsen B, de Mey J, Vanderhelst E, Vandemeulebroucke J. Ventilation heterogeneity in smokers: role of unequal lung expansion and peripheral lung structure. J Appl Physiol., 2020. doi:10.1152/japplphysiol.00105.2020.

Vos W, De Backer J, Poli G, De Volder A, Ghys L, Van Holsbeke C, Vinchurkar S, De Backer L, De Backer W. Novel functional imaging of changes in small airways of patients treated with extrafine beclomethasone/formoterol. Respiration. 2013;86(5):393-401. doi: 10.1159/000347120. Epub 2013 Apr 12. PMID: 23595105.

Ueda T, Niimi A, Matsumoto H, Takemura M, Hirai T, Yamaguchi M, Matsuoka H, Jinnai M, Muro S, Chin K, Mishima M. Role of small airways in asthma: investigation using high-resolution computed tomography. J Allergy Clin Immunol. 2006 Nov;118(5):1019-25. doi: 10.1016/j.jaci.2006.07.032. Epub 2006 Sep 12. PMID: 17088124.

Kauczor HU, Chen XJ, van Beek EJ, Schreiber WG. Pulmonary ventilation imaged by magnetic resonance: at the doorstep of clinical application. Eur Respir J. 2001 May;17(5):1008-23. doi: 10.1183/09031936.01.17510080. PMID: 11488304.

Musch G, Venegas JG. Positron emission tomography imaging of regional pulmonary perfusion and ventilation. Proc Am Thorac Soc. 2005;2(6):522-7, 508-9. doi: 10.1513/pats.200508-088DS. PMID: 16352758; PMCID: PMC2713340.

Kanazawa H, Kyoh S, Asai K, Hirata K. Validity of measurement of two specific biomarkers for the assessment of small airways inflammation in asthma. J Asthma. 2010 May;47(4):400-6. doi: 10.3109/02770901003759394. PMID: 20528593.

Okazaki S, Murai H, Kidoguchi S, Nomura E, Itoh N, Hashimoto N, Hamada T, Kawakita A, Yasutomi M, Ohshima Y. The Biomarker Salivary SP-D May Indicate Small Airway Inflammation and Asthma Exacerbation. J Investig Allergol Clin Immunol. 2017;27(5):305-312. doi: 10.18176/jiaci.0174. Epub 2017 Jun 6. PMID: 28585516.

Usmani OS. Treating the small airways. Respiration. 2012;84(6):441-53. doi: 10.1159/000343629. Epub 2012 Nov 15. PMID: 23154684.

Zinellu E, Piras B, Ruzittu GGM, Fois SS, Fois AG, Pirina P. Recent Advances in Inflammation and Treatment of Small Airways in Asthma. Int J Mol Sci. 2019 May 28;20(11):2617. doi: 10.3390/ijms20112617. PMID: 31141956; PMCID: PMC6601314.

Zainudin BM, Biddiscombe M, Tolfree SE, Short M, Spiro SG. Comparison of bronchodilator responses and deposition patterns of salbutamol inhaled from a pressurised metered dose inhaler, as a dry powder, and as a nebulised solution. Thorax. 1990 Jun;45(6):469-73. doi: 10.1136/thx.45.6.469. PMID: 2392793; PMCID: PMC462532.

Nicolini G, Scichilone N, Bizzi A, Papi A, Fabbri LM. Beclomethasone/formoterol fixed combination for the management of asthma: patient considerations. Ther Clin Risk Manag. 2008 Oct;4(5):855-64. doi: 10.2147/tcrm.s3126. PMID: 19209268; PMCID: PMC2621423.

Chrystyn H. Anatomy and physiology in delivery: can we define our targets? Allergy. 1999;54 Suppl 49:82-7. doi: 10.1111/j.1398-9995.1999.tb04393.x. PMID: 10422753.

GEMA, inhaladores. Terapia inhalada: Fundamentos, dispositivos y aplicaciones prácticas. 2018.

https://issuu.com/separ/docs/guiagemainhaladores_baja_1_?fr=sNjAxNzE2NjczNg

De Backer W, Devolder A, Poli G, Acerbi D, Monno R, Herpich C, Sommerer K, Meyer T, Mariotti F. Lung deposition of BDP/formoterol HFA pMDI in healthy volunteers, asthmatic, and COPD patients. J Aerosol Med Pulm Drug Deliv. 2010 Jun;23(3):137-48. doi: 10.1089/jamp.2009.0772. PMID: 20109122; PMCID: PMC3123836.

Singh D, Collarini S, Poli G, Acerbi D, Amadasi A, Rusca A. Effect of AeroChamber Plus™ on the lung and systemic bioavailability of beclometasone dipropionate/formoterol pMDI. Br J Clin Pharmacol. 2011 Dec;72(6):932-9. doi: 10.1111/j.1365-2125.2011.04024.x. PMID: 21615456; PMCID: PMC3244640.

Virchow JC, Poli G, Herpich C, Kietzig C, Ehlich H, Braeutigam D, Sommerer K, Häussermann S, Mariotti F. Lung Deposition of the Dry Powder Fixed Combination Beclometasone Dipropionate Plus Formoterol Fumarate Using NEXThaler® Device in Healthy Subjects, Asthmatic Patients, and COPD Patients. J Aerosol Med Pulm Drug Deliv. 2018 Oct;31(5):269-280. doi: 10.1089/jamp.2016.1359. Epub 2018 Jul 10. PMID: 29989511; PMCID: PMC6161336.

Price DB, Henley W, Cançado JED, Fabbri LM, Kerstjens HAM, Papi A, Roche N, Şen E, Singh D, Vogelmeier CF, Barille S, Nudo E, Carter V, Skinner D, Vella R, Georges G. Interclass Difference in Pneumonia Risk in COPD Patients Initiating Fixed Dose Inhaled Treatment Containing Extrafine Particle Beclometasone versus Fine Particle Fluticasone. Int J Chron Obstruct Pulmon Dis. 2022 Feb 15;17:355-370. doi: 10.2147/COPD.S342357. Erratum in: Int J Chron Obstruct Pulmon Dis. 2022 Mar 07;17:489-490. PMID: 35210765; PMCID: PMC8858000.

Sonnappa S, McQueen B, Postma DS, Martin RJ, Roche N, Grigg J, Guilbert T, Gouder C, Pizzichini E, Niimi A, Phipatanakul W, Chisholm A, Dandurand RJ, Kaplan A, Israel E, Papi A, van Aalderen WMC, Usmani OS, Price DB. Extrafine Versus Fine Inhaled Corticosteroids in Relation to Asthma Control: A Systematic Review and Meta-Analysis of Observational Real-Life Studies. J Allergy Clin Immunol Pract. 2018 May-Jun;6(3):907-915.e7. doi: 10.1016/j.jaip.2017.07.032. Epub 2017 Sep 20. PMID: 28941668.

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