Are we overlooking persistent small airways dysfunction in community-managed asthma?

Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control.