Small airway inflammation and extrafine inhaled corticosteroids plus long-acting beta2-agonists formulations in chronic obstructive pulmonary disease.
OBJECTIVES
To summarize the evidence of small airways involvement in chronic obstructive pulmonary disease (COPD) pathophysiology, and to evaluate the efficacy of extrafine formulations of inhaled corticosteroids (ICS) in combination with long-acting beta2-agonists (LABAs) in the treatment of COPD.


DATA SOURCE
A search of the PubMed database was conducted using the keywords "COPD", "small airways", "inflammation" and "extrafine formulation." The search was limited to entries published in English before August 2016. Only studies conducted in humans were considered.


STUDY SELECTION
Publications were included on the basis of relevance.


RESULTS
COPD is a common preventable and treatable disease, characterized by persistent and progressive airflow limitation. With improved understanding of COPD pathophysiology, small airways (internal diameter <2 mm), a well-known major site of COPD-associated inflammation and remodeling, have emerged as a potential target for COPD pharmacologic therapies. The ability of extrafine formulations of ICS in combination with LABAs to achieve central and peripheral lung deposition, and the implications of the enhanced efficacy that this may bring, are discussed by examining findings from the development trials plan of the extrafine formulation of beclometasone dipropionate/formoterol fumarate (Foster®, Chiesi Farmaceutici, Italy) in patients with COPD.


CONCLUSION
There is an urgent need for improved and reliable techniques for small airways assessment in order to detect early damage, disease progression and response to treatment. Evidence from randomized clinical trials supports the benefits of extrafine ICS/LABA formulations in COPD, real world studies are necessary to confirm this.
['Pirina|Pietro|P|', 'Foschino Barbaro|Maria Pia|MP|', 'Paleari|Davide|D|', 'Spanevello|Antonio|A|']
D000280:Administration, Inhalation D000305:Adrenal Cortex Hormones D058666:Adrenergic beta-2 Receptor Agonists D000335:Aerosol Propellants D056151:Airway Remodeling D001507:Beclomethasone D004304:Dosage Forms D004339:Drug Compounding D000068759:Formoterol Fumarate D006801:Humans D007249:Inflammation D029424:Pulmonary Disease, Chronic Obstructive
Inflammation Corticosteroids Chronic obstructive pulmonary disease Aerosol propellant Bronchioles