Diagnosis and Management of Small Airways Disease.

Topic Importance: Small airways diseases pose several challenges to the practicing clinician. The small airways are involved in common disorders such as asthma and COPD but are also the primary site of pathology in a host of bronchiolitis syndromes. Diagnosis is challenging and often delayed because of a lack of uniform diagnostic criteria and the limited ability of standard pulmonary testing to capture small airways dysfunction until considerable involvement has occurred. Data to guide management beyond general strategies targeting airflow obstruction are limited and largely derived from smaller case series. Review Findings: We review the literature to increase the awareness of small airways diseases, highlight clinical scenarios that should prompt consideration of nonasthma/COPD bronchiolitis syndromes, and provide a format for pulmonologists to approach small airways diseases. We describe the available data regarding treatment options and current management strategies. Summary: Small airways diseases and bronchiolar disorders are common in pulmonary practice. Recognition and proper diagnosis can be difficult. We seek to provide a comprehensive and contemporary overview of small airways diseases and management.