Effects of extra‐fine inhaled beclomethasone/formoterol on both large and small airways in asthma

Scichilone, Nicola; Battaglia, Salvatore; Sorino, Claudio; Paglino, Giuseppe; Martino, Lavinia; Paternò, Alessandra; Santagata, Roberta; Spatafora, Mario; Nicolini, Gabriele; Bellia, Vincenzo

doi:10.1111/j.1398-9995.2009.02306.x

Cited by 66 publications

(56 citation statements)

References 27 publications

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“…Treatment with extrafine BDP/formoterol leads to greater improvement in FVC compared with fluticasone/salmeterol, suggesting an effect on small airways [72]. In a recent pilot study involving 30 asthmatic patients, SCICHILONE et al [73] reported that a 12-week treatment with BDP/formoterol extrafine combination (but not with fluticasone/salmeterol) resulted in a trend toward improvement versus baseline in CC, further suggesting an improvement in small airways function. HUCHON et al [74] performed a 24-week study in 645 patients with moderate-to-severe asthma, comparing extrafine HFA-BDP/formoterol in a single inhaler to a combination of BDP and formoterol administered in larger particles via separate inhalers.…”

Section: Therapeutic Intervention In Small Airways Diseasementioning

confidence: 96%

The role of small airways in obstructive airway diseases: Figure 1.

Burgel¹

2011

Eur Respir Rev

196

139

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This review article is a summary of a seminar organised by the European Respiratory Society on ''The role of small airways in obstructive airway diseases'' which was held in October 2010 in Amsterdam, the Netherlands.The aims of the seminar were to identify important questions related to small airways involvement in asthma and chronic obstructive pulmonary disease (COPD), and to discuss future approaches based on current and evolving knowledge. Data obtained by pathological and physiological measurements in small airways and their relevance to clinical manifestations and therapeutics in asthma and COPD were reviewed.It was concluded that our knowledge on the roles of small airways in asthma and COPD is limited. Studies of large numbers of well-characterised subjects using multiple methods (genetic characterisation, cell biology and physiology, imaging) and integration of the data using mathematical models are suggested to be of interest. The availability of these techniques coupled with our ability to better target inhaled molecules to small airways provide a unique opportunity for a reappraisal of the relevance of small airways in chronic airway diseases.

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Section: Therapeutic Intervention In Small Airways Diseasementioning

confidence: 96%

The role of small airways in obstructive airway diseases: Figure 1.

Burgel¹

2011

Eur Respir Rev

196

139

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“…Imaging parameters showed further consistent improvement in airway caliber and indicated where these changes mainly occurred. It is now possible to directly observe that a dilating effect is present in both the larger and smaller airways, while this was previously only demonstrated indirectly [23]. …”

Section: Discussionmentioning

confidence: 90%

Novel Functional Imaging of Changes in Small Airways of Patients Treated with Extrafine Beclomethasone/Formoterol

et al. 2013

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Background: Inhaled formulations using extrafine particles of long-acting β₂-agonists and corticosteroids were developed to optimize asthma treatment. Findings that these combinations reach and treat smaller airways more effectively are predominantly based on general non-specific outcomes with little information on regional characteristics. Objectives: This study aims to assess long-term effects of extrafine beclomethasone/formoterol on small airways of asthmatic patients using novel functional imaging methods. Methods: Twenty-four stable asthma patients were subdivided into three groups (steroid naive, n = 7; partially controlled, n = 6; well controlled, n = 11). Current treatment was switched to a fixed combination of extrafine beclomethasone/formoterol (Foster®; Chiesi Pharmaceuticals, Parma, Italy). Patients underwent lung function evaluation and thorax high-resolution computerized tomography (HRCT) scan. Local airway resistance was obtained from computational fluid dynamics (CFD). Results: After 6 months, the entire population showed improvement in pre-bronchodilation imaging parameters, including small airway volume (p = 0.0007), resistance (p = 0.011), and asthma control score (p = 0.016). Changes in small airway volume correlated with changes in asthma control score (p = 0.004). Forced expiratory volume in 1 s (p = 0.044) and exhaled nitric oxide (p = 0.040) also improved. Functional imaging provided more detail and clinical relevance compared to lung function tests, especially in the well-controlled group where only functional imaging parameters showed significant improvement, while the correlation with asthma control score remained. Conclusions: Extrafine beclomethasone/formoterol results in a significant reduction of small airway obstruction, detectable by functional imaging (HRCT/CFD). Changes in imaging parameters correlated significantly with clinically relevant improvements. This indicates that functional imaging is a useful tool for sensitive assessment of changes in the respiratory system after asthma treatment.

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“…In addition, 12 weeks of extrafine BDP/F combination treatment tended to be significantly superior to equipotent doses of non-extrafine FP/S in improving closing capacity measured by the sbN 2 washout test [79]. These latter results provide direct evidence of the superiority of the extrafine ICS/LABA combinations compared to the non-extrafine combinations in improving small-airways function, possibly linked to the higher proportion of small particle delivered by extrafine formulations able to reach the more peripheral airway tract [80].…”

Section: Accessing the Peripheral Airways: Current Evidence And Futurmentioning

confidence: 89%

Assessing and accessing the small airways; implications for asthma management

Scichilone

Contoli

Paleari

et al. 2013

Pulmonary Pharmacology & Therapeutics

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a b s t r a c tDespite the wealth of experience in the management of asthma, the disease remains inadequately controlled in some patients, who face long-term respiratory impairment and disability. The disease has been characterised as an inflammatory condition affecting first the larger airways and eventually the smaller airways, but there is evidence that peripheral airway involvement defines a particular and more severe phenotype of asthma. For this reason, assessing functional and biological parameters reflective of small airways involvement is important prognostically. No assessment method is universally and directly representative of peripheral airway function, but the traditional spirometric tests, including vital capacity, residual volume and forced vital capacity, are somewhat correlated with this function; useful methods for further assessment include the single-breath nitrogen wash-out test, impulse oscillometry, nitrous oxide and exhaled breath concentrate measurements, as well as computed tomography to reflect air trapping and response to treatment. Formulation advancements have made for easier treatment access to the smaller airways, with the new extrafine formulations resulting in better asthma control compared with non-extrafine formulations.

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Effects of extra‐fine inhaled beclomethasone/formoterol on both large and small airways in asthma

Abstract: The findings of this pilot study suggest that an extra-fine inhaled combination for the treatment of asthma has beneficial effects on both large and small airways function as expressed by Mch and sbN(2) tests.

Cited by 66 publications

References 27 publications

The role of small airways in obstructive airway diseases: Figure 1.

The role of small airways in obstructive airway diseases: Figure 1.

Novel Functional Imaging of Changes in Small Airways of Patients Treated with Extrafine Beclomethasone/Formoterol

Assessing and accessing the small airways; implications for asthma management

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