Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (

Juan Carlos Ivancevich Monday, 31 October 2016 15:19
F. Braido, N. Scichilone, F. Lavorini, O. S. Usmani, L. Dubuske, L. P. Boulet, R. Mosges, C. Nunes, M. Sánchez-Borges, I. J. Ansotegui, M. Ebisawa, F. Levi-Schaffer, L. J Rosenwasser, J. Bousquet, T. Zuberbier, G. Walter CanonicaEmail author, for the Interasma Executive Board, WAO Board of Directors, ARIA and GA²LEN


Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases.

Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change.

The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction.

In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant.

Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy.

This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.

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Asthma Research and Practice - Submission guidelines

Juan Carlos Ivancevich Friday, 14 October 2016 22:36

Asthma Research and Practice

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Juan Carlos Ivancevich Monday, 26 September 2016 16:11

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Asthma phenotypes: the intriguing selective intervention with Montelukast

Juan Carlos Ivancevich Wednesday, 17 August 2016 03:58

Cottini Marcello and Lombardi Carlo


Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation and a variable course associated with various underlying mechanisms that can differ between individuals. Patients with asthma can therefore exhibit different phenotypes, a term used to define the observable characteristics of an organism resulting from the interaction between its genetic makeup and the environment. The heterogeneity of asthma has received a large amount of attention in the last few years in order to better tailor treatment according to the different clinical and biological phenotypes of the disease. Specific asthma phenotypes may require an approach to treatment sometimes different from that recommended by current guidelines, so a personalized approach to asthma pharmacotherapy is recommended. Growing evidence suggests that leukotrienes play an important role in the pathogenesis of bronchial asthma. The mechanisms of action of leukotriene-receptor antagonists theoretically predict a good response in some asthma “phenotypes”.In this article we have performed an analysis of the recent literature (controlled clinical trials and real-life studies) about a possible selective intervention with Montelukast in specific asthma phenotypes.

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The management of asthmatic smokers

Juan Carlos Ivancevich Monday, 27 June 2016 18:28
José Miguel Chatkin Email author and Cynthia Rocha Dullius



Asthma is still a major public health problem in most countries; new strategies to better control this disease are necessary. Such strategies must include predisposing factors. One of these factors is smoking and a significant fraction of asthmatics are smokers. However, clinical trials studying new drugs or newer therapeutic regimens for asthma generally exclude smokers. Therefore, there is a lack of specific information about the treatment of asthma in smokers. The asthmatic smoker is a special phenotype with important therapeutic and prognostic clinical implications. Any form of tobacco use, especially cigarette smoking, plays an important role in this disease. Asthmatic smokers are prone to several negative outcomes. Smoking cessation results in an improvement of symptoms and pulmonary functioning. Counselling and first-line medications for smoking cessation (nicotine replacement therapy, bupropion and varenicline) significantly increase quitting rates. The role of electronic cigarettes in this group of patients has only begun to be studied. The treatment of asthmatics that smoke has characteristics that need must be well understood by clinicians, especially the poor response to corticosteroids. This condition is not universal and physicians should always consider its inclusion in the treatment of these patients. The association of inhaled corticosteroids (ICS) plus a long-acting beta2 adrenegic (LABA) by smoking asthmatics results in more pronounced improvement in several asthma outcomes compared with the use of corticosteroid alone. Inhaled corticosteroids in extra-fine particles associated with LABA may be a new perspective of treatment. Also the use of leukotriene antagonists may become another therapeutic alternative. The purpose of this narrative review is to discuss the challenges faced by clinicians to control asthma in smokers and to present methods of coping with smoking treatment and avoiding relapses.

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Asthma Research and Practice celebrates its first anniversary

Juan Carlos Ivancevich Monday, 06 June 2016 17:54

As open access journal Asthma Research and Practice celebrates its first anniversary, we are pleased to bring you a selection of recently published articles. We hope you find the articles of interest and invite you to submit your next manuscript to the journal.

We also encourage you to read our blog post for World Asthma Day as well as more asthma-related posts.

Featured Articles


Asthma and obesity: mechanisms and clinical implications

Cynthia Wilson Baffi, Daniel Efrain Winnica and Fernando Holguin

Abstract   |  Full text   |  PDF


Vitamin D supplementation decreases Aspergillus fumigatus specific Th2 responses in CF patients with aspergillus sensitization: a phase one open-label study

Nguyen et al.

Abstract   |  Full text   |  PDF


A qualitative evaluation of the implementation of guidelines and a support tool for asthma management in primary care

Watkins et al.

Abstract   |  Full text   |  PDF

About the Journal

Asthma Research and Practice is the official publication of Interasma and publishes cutting edge basic, clinical and translational research in addition to hot topic reviews and debate articles relevant to asthma and related disorders (such as rhinitis, COPD overlapping syndrome, sinusitis). The journal has a specialized section which focusses on pediatric asthma research.

Asthma Research and Practice aims to serve as an international platform for the dissemination of research of interest to pulmonologists, allergologists, primary care physicians and family doctors, ENTs and other health care providers interested in asthma, its mechanisms and comorbidities.

Reasons to Publish with Us

  • The official journal of Interasma
  • Dedicated section on pediatric asthma
  • Translating research from bench to bedside



Asthma Research and Practice: Potential of molecular based diagnostics and its impact on allergen immunotherapy

Juan Carlos Ivancevich Friday, 03 June 2016 12:43


The following new article has just been published in Asthma Research and Practice


Potential of molecular based diagnostics and its impact on allergen immunotherapy

Melioli G, Savi E, Crivellaro M, Passalacqua G

Asthma Research and Practice 2016, 2 :9 (2 June 2016)


Molecular based in vitro technologies greatly changed the diagnostic approaches in allergy. At present, sensitization profiles can be dissected according to IgE subsets, which are specific for genuine or cross-reacting components and potentially dangerous or virtually harmless components. The identification of IgE in components with specific characteristics has a direct impact on the accuracy of the diagnosis (indeed, it is possible at present to not only identify the allergen derived from a given allergen source but also the family of molecules to which the patient is sensitized), on the prognosis of the patient’s allergy, and on the prevention activities to be implemented. More interestingly, during the last few years, and thanks to the tools of molecular diagnostics, the indications for Allergen Immunotherapy (AIT) have also be modified, and novel strategies for the selection of the allergens to be administered have been better defined. Indeed, protocols indicating how Molecular Based Diagnosis (MBD) can be used to identify the best AIT approach have been recently published. In this review, the rationale for the use of MBD tools is discussed, and the recent strategies for the choice of allergens to be used in AIT are reported.

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May 2nd is Now "Bronchial Thermoplasty Awareness Day" in Pennsylvania

Juan Carlos Ivancevich Friday, 13 May 2016 22:21

 Asthma is a disease that causes the airways of the lungs to swell and narrow, leading to wheeze, shortness of breath, chest tightness, and cough. Asthma is the most common chronic lung disease, affecting up to 10% of adults and 30% of children. Bronchial Thermoplasty (BT) is one of the treatment options for severe asthma - see below:

Asthma Treatment Options in 6 Steps (click to enlarge the image).

May 2nd is Now "Bronchial Thermoplasty Awareness Day" in Pennsylvania. From the manufacturer's YouTube channel: Bronchial Thermoplasty Day in Pennsylvania

Here is how the procedure looks like, again from the manufacturer's channel:


International respiratory societies call for collaboration on asthma

Juan Carlos Ivancevich Friday, 06 May 2016 20:55

The Forum of International Respiratory Societies (FIRS) is calling for improved collaboration and funding to prevent and treat asthma.

In advance of World Asthma Day on May 3, the Forum of International Respiratory Societies issues a call to arms.

In World Asthma Day on May 3, FIRS says stakeholders must collaborate locally and globally to ensure adequate funding and resources are available to implement effective preventative and therapeutic strategies.

FIRS brings together the world’s leading international respiratory societies to work together to improve lung health globally. Members include the European Respiratory Society (ERS), International Union Against Tuberculosis and Lung Disease (The Union), the American Thoracic Society (ATS), and the American College of Chest Physicians (CHEST). The goal of the Forum is to unify and enhance efforts to improve lung health through the combined work of its 70,000+ members globally.

According to the Global Asthma Report 2014, up to 334 million people worldwide have asthma. Approximately 4.5% of young adults have been diagnosed with asthma and/or are taking asthma medication. An estimated 14% of children have had asthma symptoms in the past year.

In a statement issued by the ATS, FIRS says leaders in respiratory health must unite globally to invest in community-led solutions to improve quality of life, and reduce morbidity and mortality in asthma. It is calling on countries and organisations to invest and take necessary actions to encourage people-centred prevention, treatment and care to ensure that every person with asthma has access to high-value care.

World Asthma Day is an annual event organised by the Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world. The theme for this year’s event is ‘You can control your asthma’ and it will be held on May 3.

The following new article has just been published in Asthma Research and Practice

Juan Carlos Ivancevich Thursday, 05 May 2016 13:04


A qualitative evaluation of the implementation of guidelines and a support tool for asthma management in primary care

Watkins K, Fisher C, Misaghian J, Schneider C, Clifford R

Asthma Research and Practice 2016, 2 :8 (4 May 2016)

Abstract | Full Text | PDF

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Editor: Juan C. Ivancevich, MD

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