If your patient with asthma wheezes when sitting or lying quietly, lung function testing may reveal small airway disease

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The paradigm of “small airway disease” (SAD) continues to be advanced with considerable enthusiasm by clinicians and scientists alike [1, 2], having full knowledge that the binary classification of airways as “small” or “large” is somewhat arbitrary [3, 4]. Nonetheless, important questions that remain unanswered are: 1) how does SAD manifest; 2) how do we detect SAD, ideally in a cost-effective manner that can be adopted in primary care; and finally 3) once a patient has been classified as having SAD, what can we do about it? The second of these questions is amply addressed in the present issue of the European Respiratory Journal by Kocks et al. [5].