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April 13, 2021 / in Scientific Article

Abstract

Background

Asthma, an inflammatory disease affecting more than 300 million patients in the world. Small airways are by far bigger than the large airway’s one and constitutes the area most affected by asthma. Reaching the small airways represents a challenge for treatments because of the dimensions and structure of the bronchial lumen. Inhaled extrafine (ExF) combinations are needed to reach and treat them. This study aimed to assess the effect of extrafine Beclometasone dipropionate/Formoterol fumarate (BDP/FF) in the control of symptoms, lung function and lung inflammation in patients with asthma.

Methods

Retrospective study, carried out in 62 Mexican patients diagnosed with asthma and treated with two inhalations twice daily of ExF BDP/FF 100/6 μg (via pMDI) and with an Asthma Control Test (ACT) score ≤19 points. Moreover, from patient’s files, we analyzed ACT score, Impulse Oscillometry (IOS) and Fractional exhaled Nitric Oxide (FeNO) both from their first consultation (baseline) and after one month of therapy.

Results

BDP/FF 100/6 μg ExF showed that ACT, 79% of patients achieved control of disease (ACT ≥ 20 points) and 14.5% of patients achieved total control of the disease (ACT = 25 points); Oscillometry values R5- R20 diminished by 41%, X5 by 18.1% and AX by 56.5% and FeNO decreased by 52% after one month of treatment.

Conclusions

BDP/FF 100/6 μg extrafine improved asthma control after one month of treatment, and this was sustained for 3 months. Likewise, both the lung function, measured by IOS and inflammatory state, measured by FeNO, also significantly improved.

The articles include uses of tremoflo products or describes research devices that may not have been cleared by FDA
Keywords
Asthma, ACT, IOS, FENO, Small airways, Extrafine particles
Source

Díaz-García R, Flores-Ramírez G, Ramírez-Oseguera RT. Effect of extrafine formulation of BDP/FF inhaler on asthma control, small airway function and airway inflammation among Mexican asthmatic patients. A retrospective analysis. Respir Med [Internet]. 2020 Mar 10 [cited 2020 Mar 17];165:105932

Other resources of interest

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In an issue of CHEST (September 2020), Karakioulaki et al1 reinforced mounting evidence for the presence of regionally heterogeneous airway abnormalities in patients with asthma by showing histopathologic airway differences across lung lobes on endobronchial biopsy. At the lobar level, airway smooth muscle cell mass and the distance between the basement membrane and airway smooth muscle were significantly different across lobes. Airway smooth muscle cell mass was greater in lower lobes compared with upper lobes, and, although specific interlobar differences were not measured, the right upper lobe notably exhibited the least amount of airway smooth muscle mass.
June 9, 2022
Longitudinal monitoring of asthma in the clinic using respiratory oscillometry
Asthma guidelines emphasize the importance of assessing lung function and symptoms. The forced oscillation technique (FOT) and its longitudinal relationship with spirometry and symptoms are unresolved. We examined concordance between longitudinal spirometry, FOT and symptom control, and determined FOT limits of agreement in stable asthma.
June 9, 2022
Criteria for Airway Oscillometry Reversibility in Asthma
We read with interest the article in the June 2020 issue of CHEST from Cottee et al,1 examining 52 patients with asthma, which concluded that bronchodilator response to albuterol 400 mg using forced oscillation technique (airway oscillometry [AO]) with Thorasys Tremoflo was more sensitive than spirometry at identifying poor disease control with the asthma control test.1 This pattern was observed for reactance area (AX) and reactance at 5Hz but not for resistance at 5Hz (R5).
May 2, 2022
Regional Airway Heterogeneity in Asthma
In an issue of CHEST (September 2020), Karakioulaki et al1 reinforced mounting evidence for the presence of regionally heterogeneous airway abnormalities in patients with asthma by showing histopathologic airway differences across lung lobes on endobronchial biopsy. At the lobar level, airway smooth muscle cell mass and the distance between the basement membrane and airway smooth muscle were significantly different across lobes. Airway smooth muscle cell mass was greater in lower lobes compared with upper lobes, and, although specific interlobar differences were not measured, the right upper lobe notably exhibited the least amount of airway smooth muscle mass.
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