Lungenfunktionsdiagnostik der kleinen Atemwege

Zusammenfassung

Die Beteiligung der kleinen Atemwege an der Pathogenese obstruktiver Atemwegserkrankungen ist in den letzten Jahren zunehmend ins Zentrum des Interesses gerückt. Insbesondere bei schwerem und unkontrolliertem Asthma bronchiale scheint die Entzündung in den kleinen Atemwegen im Mittelpunkt zu stehen und stellt eine wichtige Targetregion für die Inhalationstherapie dar. Bislang gibt es keinen Goldstandard zur differenzierten funktionellen Erfassung der kleinen Atemwege. Verschiedene invasive und nichtinvasive Methoden wurden beschrieben. Spirometrie und Bodyplethysmografie können mit Parametern wie Verhältnis der forcierten zur langsam gemessenen Vitalkapazität (FVC/SVC) oder dem Residualvolumen (RV) nur indirekte Hinweise auf ein „air trapping“ im Rahmen einer „small airway disease“ geben. Als sensitivere Verfahren stehen die Impulsoszillometrie, Stickstoffauswaschtests und die Analyse von Stickstoffmonoxid im Exhalat zur Verfügung. Die Impulsoszillometrie separiert zentrale und periphere obstruktive Ventilationsstörungen. Mit dem Stickstoffauswaschtest werden „air trapping“ und inhomogene Ventilation in den kleinen Atemwegen erfasst. Die Berechnung der alveolären NO-Konzentration im Exhalat gilt als Marker für eine periphere Entzündung. In welcher Kombination die genannten Methoden zur Diagnostik und Beurteilung des Therapieansprechens von Patienten mit einer „small airway disease“ in der Praxis am besten eingesetzt werden, müssen zukünftige Studien zeigen.

Abstract

In the recent years growing interest has focused on the involvement of the distal airways (internal diameter < 2 mm) in obstructive lung diseases and other pulmonary conditions. Inflammation in the small airways seems to play a major role in severe and uncontrolled asthma as a major determinant of airflow obstruction. Thus, small airways represent an important target for inhalation therapy. Currently there is no accepted single lung function parameter to detect small airway dysfunction. Various invasive and non-invasive techniques have been described. In future, non-invasive lung function testing will gain more importance. Using spirometry or body plethysmography, lung function parameters such as the ratio of forced vital capacity to slow vital capacity (FVC/SVC) and the residual volume (RV) can provide information about air trapping in small airway disease. Recent data show that techniques such as impulse oscillometry, nitrogen washout testing and analysis of exhaled nitric oxide are promising tools to assess involvement of the small airways. Impulse oscillometry is a sensitive method to calculate peripheral airway resistance, nitrogen washout allows one to detect air trapping and inhomogeneous ventilation in the distal lung, and the alveolar nitric oxide concentration represents a marker of peripheral inflammation. Further studies are needed to validate these functional tests or their combination for diagnosis and assessment of treatment response in pulmonary diseases involving small airways.

^* Für die DESA
DESA (Deutsche Expertengruppe Small Airways) sind Dr. Peter Haidl, Prof. Dr. Martin Kohlhäufl, Dr. Dr. Joachim Körner, Prof. Dr. Dr. Claus Kroegel, Manuela Kulle, Dr. Detlef Nachtigall, Dr. Astrid Riebeling, Prof. Dr. Andreas Schmitt, Prof. Dr. Thomas Voshaar.

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