Abstract
Small airways disease (SAD) in bronchial asthma (BA) has been characterized in detail, yet it is rarely assessed in routine care and is not reflected in current stepwise treatment algorithms. In the ATLANTIS (Assessment of Small Airways Involvement in Asthma) study, signs of SAD were detectable in 91% of patients with BA, and an oscillometry-based composite score predicted asthma control and exacerbation risk independently of forced expiratory volume in 1 second. The aim of publishing the resolution of the Expert Council was to summarize the evidence on the clinical relevance of SAD, to define the diagnostic methods available in Russian health care, and to clarify the place of extrafine inhaled formulations within the treatment algorithm. SAD should be regarded as a treatable trait of asthma and assessed routinely in patients who do not achieve control. Impulse oscillometry with assessment of R5–R20 (resistance at 5 Hz – 20 Hz), area of reactance (AX) and X5 (reactance at 5 Hz) was endorsed as the method of choice; where IOS is unavailable, FEF25–75 may be used provided forced vital capacity is normal. Extrafine inhaled corticosteroids (ICS) are associated with a higher likelihood of achieving control (odds ratio 1.34; 95% confidence interval 1.22–1.46) and a lower exacerbation rate (rate ratio 0.84, 95% confidence interval 0.73–0.97) at a mean prescribed ICS dose 170 μg/day lower. When control is not achieved on ICS/LABA (long-acting β2-agonist) or ICS/LABA/LAMA (long-acting muscarinic antagonist), switching to an extrafine formulation within the same treatment step should be considered before the ICS dose is increased.