Abstract：
The objective of this review is to provide new advances in our understanding of the clinical importance of establishing peripheral airway impairment (PAI) by impulse oscillometry (IOS) and targeted therapy, which could result in better asthma outcomes. Data sources include PubMed and Google search, limited to English language and human disease, with key words IOS and asthma. Key findings include PAI being consistently associated with uncontrolled asthma across ethnicities, using IOS reference equations factoring Hispanic and White reference algorithms. It is noted that PAI is common even in patients considered well-controlled by asthma guidelines. In a large longitudinal analysis (Assessment of Small Airways Involved in Asthma or ATLANTIS study), a composite of R5-R20, AX, and X5 ordinal scores were independently predictive of asthma control and exacerbation in a multivariate analysis, but forced expiratory volume in 1 second was not significantly predictive of morbidities. However, combining forced expiratory volume in 1 second less than 80% with PAI resulted in greater odds of identifying uncontrolled asthma and exacerbations, than either alone. Applying an external validation method in children with asthma offers the clinician the IOS reference equations best fit for their own specific population. Several clinical phenotypes can also identify PAI with high probability, useful when IOS is not available. Poor asthma outcomes for obese patients with asthma are associated with dysanapsis and PAI, not obesity alone. Extrafine inhaled corticosteroids achieve better asthma control and improve peripheral airway function with fewer exacerbations at lower dosages than nonextrafine inhaled corticosteroid aerosols. In conclusion, these data support the benefit of adding IOS to spirometry in future asthma guidelines and suggest the potential benefit from targeted therapy.
摘要：
这篇综述的目的是为我们理解通过脉冲振荡法（IOS）建立外周气道损伤（PAI）的临床重要性提供新进展，和靶向治疗,这可能会导致更好的哮喘结局。数据源包括PubMed和Google搜索，仅限于英语和人类疾病，关键词IOS和哮喘。主要发现：使用IOS参考方程，PAI与不受控制的哮喘在不同种族之间始终相关，使用西班牙裔和白人参考算法。即使在哮喘指南认为控制良好的患者中，PAI也很常见。在一项大型纵向分析(ATLANTIS研究)中，在多变量分析中，R5-R20、AX和X5序数评分是哮喘控制和急性加重的独立预测因素，但FEV1对发病率无显著预测作用.然而,将FEV1<80％与PAI相结合，可以发现不受控制的哮喘和急性发作的可能性更大。而不是一个人。在哮喘儿童中应用外部验证方法为临床医生提供了最适合其特定人群的IOS参考方程。几种临床表型也可以以高概率识别PAI，当IOS不可用时有用。肥胖哮喘患者的不良哮喘结局与呼吸困难和PAI相关，不仅仅是肥胖。超细吸入糖皮质激素（EF-ICS）实现更好的哮喘控制，与非EF-ICS气雾剂相比，在较低剂量下恶化较少，以及改善外周气道功能。总之,这些数据支持在未来的哮喘指南中将IOS添加到肺活量测定中的益处，并提示靶向治疗的潜在益处。
