A Review on the Role of Oscillometry and Ciclesonide in Small Airway Disease Management in Asthma

Dr. Shwetangi Tyagi, Dr. Vijay S Khatri

Abstract: Asthma is a chronic inflammatory respiratory disease characterized by reversible airflow obstruction, airway hyperresponsiveness, and persistent inflammation. Small airway disease (SAD) has an important role in the pathophysiology of asthma, especially in cases of severe disease or poorly controlled asthma. Dysfunction of small airways (?2 mm in diameter) leads to the events of exacerbation, gas trapping, and impaired lung function, while detection remains poor due to the limitations of conventional pulmonary function tests. Impulse oscillometry (IOS) provides a new avenue of small airway assessment through a sensitivity measurement of airway resistance and reactance at different frequencies without patient effort, particularly in small airways. Measurements such as R5-R20, X5, and AX correlate well with the degree of asthma receptors and provide greater accuracy in diagnoses over spirometry techniques. The inhaled corticosteroid ciclesonide is considered for SAD due to its ultrafine particle size, ensuring deep lung penetration with minimal systemic effects. Preliminary evidence suggests that ciclesonide can have a favorable effect on small airway function, exacerbation prevention, and asthma control. The review outlines the pathophysiology of SAD, the oscillometry in diagnosis, and the therapeutic role of ciclesonide, ending with the need for further studies that could finalize the way for focused therapy for the small airway in asthma.

Keywords: Asthma, Ciclesonide, Impulse oscillometry, Inhaled corticosteroids, Pulmonary function, Small airway disease