Objective: To review the role of distal lung inflammation in asthma.
Data sources and study selection: Selected peer-reviewed research publications retrieved from MEDLINE search. Search was restricted to English-language publications only. Included articles were selected for their relevance to pathophysiology, diagnosis, and treatment. Bibliographies of selected papers served as an additional source of considered publications.
Results: Inflammation in the small airways and alveolar tissue plays an important role in the clinical manifestations of asthma. Diagnostic modalities such as transbronchial biopsy and evolving radiologic techniques such as high-resolution computed tomography are improving our ability to evaluate this portion of the lung. New ultra-fine particle size metered-dose inhalers and oral agents such as cysteinyl leukotriene receptor antagonists offer new opportunities for treating small airways inflammation and need to be fully evaluated for their ability to target and treat distal lung inflammation.
Conclusions: Distal lung inflammation is an important component of airway inflammation in asthma. New modalities for evaluating distal airway inflammation and for targeting the distal lung with inhaled and systemic drugs are rapidly expanding our knowledge of the clinical importance of distal lung inflammation and may ultimately be of critical importance in asthma therapy.