TY - JOUR T1 - Improved prediction of asthma exacerbations by measuring distal airway inflammation JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01684-2021 SP - 2101684 AU - Emmanouil Paraskakis AU - Evangelia Sarikloglou AU - Sotirios Fouzas AU - Paschalis Steiropoulos AU - Aggelos Tsalkidis AU - Andrew Bush Y1 - 2022/01/01 UR - http://erj.ersjournals.com/content/early/2022/01/20/13993003.01684-2021.abstract N2 - The function of the distal airway generations has in the past been difficult to assess, and in particular spirometry is insensitive to small airway disease. Novel physiological tools such as the Forced Oscillation Technique (FOT) and multiple breath washout (MBW) have demonstrated that distal disease makes an important contribution to asthma severity. Distal obstruction may result from many different factors, including remodelling, inflammation, airway instability due to loss of alveolar tethering attachments and mucus plugging. Distal airway disease is known to independently contribute to the severity of airway hyper-responsiveness in asthma [1] but unsurprisingly there is a poor correlation between distal inflammation measured directly and physiological parameters [2–4]. Distal inflammation can be studied directly using transbronchial biopsy and has been implicated in the severity of asthma [5], but this invasive technique is not suitable for routine monitoring and especially not in children.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Emmanouil ParaskakisConflict of interest: Evangelia SarikloglouConflict of interest: Sotirios FouzasConflict of interest: Paschalis SteiropoulosConflict of interest: Aggelos TsalkidisConflict of interest: Andrew Bush ER -