Treatment response according to small airways disease status: The effects of high-strength extrafine pMDI beclomethasone dipropionate/formoterol fumarate in fixed dose combination in moderate uncontrolled asthmatic patients. (February 2020)

• Record Type: Journal Article
• Authors: Carpagnano, Giovanna E.; Scioscia, Giulia; Lacedonia, Donato; Stornelli, Silvia Romana; Irene Quarato, Carla Maria; Soccio, Piera; Resta, Onofrio; Foschino Barbaro, Maria Pia
• Is Part Of: Pulmonary pharmacology & therapeutics. Volume 60(2020)
• Publication Date: 2020-02
• Subjects: Uncontrolled asthma -- Small airways phenotype -- Small airways disease -- High-strength extrafine ICS/LABA in fixed dose -- Pressurized metered-dose inhaler -- Fractional exhaled nitric oxide -- Exhaled breath condensate; Respiratory organs -- Diseases -- Chemotherapy -- Periodicals; 615.7205
• DOI: 10.1016/j.pupt.2019.101879
• Languages: English
• ISSNs: 1094-5539

Abstract

Abstract: Background: Inflammation in small airways is particularly clinically active in severe asthma but they still continue to be ignored as considered silent. Recently, the Atlantis study reports small airways involvement in 91% of the asthma population. Therefore in the era of phenotype driven therapy, the aim of this study was to verify if high-strength extrafine ICS/LABA in fixed dose increases clinical efficacy in moderate asthmatic patients with small airways dysfunction and it could be proposed as phenotype driven therapy. Methods: In this prospective, non-interventional, real-life pilot study we enrolled 37 consecutive patients with moderate asthma who were uncontrolled despite GINA step 3 treatment. All subjects at enrollment were divided in two groups according to the presence of small airways dysfunction:1) small airways phenotype (SAP) group: smokers (≥10 packs/die), ex-smokers (>20 packs/year) with air trapping (FVC <80% - VR >100% - FEF 25–75% <60%); 2) non-small airways phenotype (NSAP) group: non-smokers, without air trapping (FVC ≥80% - VR ≤ 100% - FEF 25–75% ≥60%). We later proceeded in both groups with a step up in therapy with high-strength extrafine pMDI beclomethasone dipropionate/formoterol fumarate (BDP/FF) (200/6 μg) in fixed dose to achieve a better control and followed patients for 6 months. Results: Treatment with extrafine BDP/FF(200/6 μg) in SAP group showed a more significant improvement of FEF25-75%, FVC, RV, and a reduction of alveolar inflammatory markers such as FENO350 and alveolar exhaled pH compared with NSAP patients. Conclusions: Our preliminary results support the use of high-strength extrafine pMDI BDP/FF (200/6 μg) as phenotype driven treatment directed to small airways dysfunction demonstrating an increase of clinical efficacy in moderate asthmatics with SAP. Highlights: Uncontrolled asthma patients often present an inflammatory small airways' involvement. The detection of small airways phenotype is still far from a common clinical practice. 32 moderate asthmatics were divided in two group according to the presence of small airways dysfunction. Small airways can be studied by lung function and measuring inflammatory markers in non-invasive samples. Efficacy of high-strength extrafine pMDI BDP/FF (200/6 μg) increased in moderate asthmatics with small airways disfunction.