Detecting Small Airways Dysfunction in Asthma: Rationale, Findings, and Future of ATLANTIS

Small airway dysfunction (SAD) is both common and clinically relevant in patients with asthma. However, there is no recognized "gold standard" approach for the identification of SAD in clinical practice. The ATLANTIS (AssessmenT of smalL Airways involvemeNT In aSthma) study was a prospective (1-year follow-up), multicenter, international observational study that aimed to identify the best, or best combination of biomarkers, physiological tests, and imaging markers for the determination of the presence of SAD, and to evaluate the contribution of SAD across all asthma severities to meaningful clinical asthma outcomes. A large number of analyses from the ATLANTIS study have been conducted or are planned. This narrative review summarizes the key findings to date and the future directions. Perhaps the most important finding so far is that a "toolbox" of spirometry, oscillometry, and a small airways dysfunction questionnaire can detect SAD with high accuracy (area under the receiver operating characteristic curve 0.96 and positive likelihood ratio 12.8). Further, collaboration with other consortia has demonstrated the use of oscillometry to identify asthma phenotypes. We advocate the adoption of the ATLANTIS toolbox into interventional studies in asthma-and if validated, this could form a useful part of research and daily clinical practice.

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Publication Details

Journal
The Journal of Allergy and Clinical Immunology In Practice
Published
2025-08-22
DOI
https://doi.org/10.1016/j.jaip.2025.08.013
Citations
2
Primary Topic
Asthma and respiratory diseases
Type
article
Field-Weighted Citation Impact
2.33

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article

Detecting Small Airways Dysfunction in Asthma: Rationale, Findings, and Future of ATLANTIS

Maarten van den Berge, Salman Siddiqui, Leonardo M. Fabbri, Klaus F. Rabe et al.
2 citations
The Journal of Allergy and Clinical Immunology In Practice
Asthma and respiratory diseases
2.33
article

Detecting Small Airways Dysfunction in Asthma: Rationale, Findings, and Future of ATLANTIS

Maarten van den Berge, Salman Siddiqui, Leonardo M. Fabbri, Klaus F. Rabe, Alberto Papi, Marielle Van Der Deijl, Christopher Edward Brightling, Dave Singh, Janwillem Kocks, Monica Kraft
article en
2 citations

Abstract

Small airway dysfunction (SAD) is both common and clinically relevant in patients with asthma. However, there is no recognized "gold standard" approach for the identification of SAD in clinical practice. The ATLANTIS (AssessmenT of smalL Airways involvemeNT In aSthma) study was a prospective (1-year follow-up), multicenter, international observational study that aimed to identify the best, or best combination of biomarkers, physiological tests, and imaging markers for the determination of the presence of SAD, and to evaluate the contribution of SAD across all asthma severities to meaningful clinical asthma outcomes. A large number of analyses from the ATLANTIS study have been conducted or are planned. This narrative review summarizes the key findings to date and the future directions. Perhaps the most important finding so far is that a "toolbox" of spirometry, oscillometry, and a small airways dysfunction questionnaire can detect SAD with high accuracy (area under the receiver operating characteristic curve 0.96 and positive likelihood ratio 12.8). Further, collaboration with other consortia has demonstrated the use of oscillometry to identify asthma phenotypes. We advocate the adoption of the ATLANTIS toolbox into interventional studies in asthma-and if validated, this could form a useful part of research and daily clinical practice.

The Journal of Allergy and Clinical Immunology In PracticeVol. 14(1)
Mount Sinai Health System (US), University Medical Center Groningen (NL), University of Leicester (GB), University of Groningen (NL), University of Ferrara (IT), National Institute for Health and Care Research (GB), Manchester University NHS Foundation Trust (GB), General Practitioners Research Institute (NL), NIHR Imperial Biomedical Research Centre (GB), German Center for Lung Research (DE), LungenClinic Grosshansdorf (DE), Chiesi (Italy) (IT), NIHR Leicester Biomedical Research Centre (GB), Chiesi (France) (FR)
American Thoracic Society, AstraZeneca, GlaxoSmithKline, Sanofi, Chiesi Farmaceutici, CSL Behring, Regeneron Pharmaceuticals, Moderna, Glenmark Pharmaceuticals, National Institute for Health and Care Research, Deutsches Zentrum für Lungenforschung, National Institutes of Health, Genentech, Manchester Biomedical Research Centre, NIHR Imperial Biomedical Research Centre, NIHR Leicester Biomedical Research Centre
Openalex Percentile: Top 11%
Asthma and respiratory diseases
2.33
DOIOpen Access PDFOpenAlex
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