Therapie der kleinen Atemwege: Grundlagen und Möglichkeiten

Zusammenfassung

Der Beitrag zeigt die Möglichkeiten auf, die kleinen Atemwege („small airways“) gezielt zu erreichen. Neben der Therapie chronisch obstruktiver Lungenerkrankungen kann dies für die Entwicklung von Behandlungskonzepten unterschiedlicher Bronchiolitiden von großer Bedeutung sein. Kleine Aerosolpartikel, ein langsamer und möglichst kontrollierter Inspirationsfluss und eine Atemanhaltezeit nach Inhalation von 5 – 10 sec für Steroidpartikel sind essentielle Einflussfaktoren für eine periphere Lungendeposition. Klinische Daten zum Vergleich von Steroiden mit extrafeiner und konventioneller Partikelgröße bei Asthma bronchiale liegen insbesondere aus methodischen Gründen nur begrenzt vor. Extrafeine Steroidaerosole zeigten einen Trend zur Reduktion von Symptomen, zur positiven Beeinflussung von Biomarkern und zur Abnahme der Lungenüberblähung.

Abstract

This paper describes the possibility of targeting the small airways. In addition to aiding in the therapy for chronic obstructive lung diseases this may prove to be invaluable in the development of treatment strategies for diseases of the bronchioli. Essential factors in peripheral lung deposition include extra-fine particles, a slow and controlled inspiratory flow and an endexspiratory breathhold of 5 – 10 sec (especially for steroids). Due to methodological difficulties, clinical data comparing steroids with larger or extra-fine particles are limited in the field of asthma therapy. However, research suggests a trend for reduced symptoms, positively affected biomarkers and decreased lung hyperinflation when steroids with extra-fine particles are used.

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