Prescribing practices and asthma control with hydrofluoroalkane-beclomethasone and fluticasone: A real-world observational study

Price, David; Martin, Richard J.; Barnes, Neil; Dorinsky, Paul; Israel, Elliot; Roche, N.; Chisholm, Alison; Hillyer, Elizabeth V.; Kemp, Linda; Lee, Dean A.; Ziegenweidt, Julie von; Colice, Gene

doi:10.1016/j.jaci.2010.06.040

Cited by 69 publications

(64 citation statements)

References 34 publications

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“…These results are strengthened by a similar study showing that asthmatic patients treated with extrafine-particle HFA-beclomethasone more frequently achieve asthma control than those treated with coarse-particle treatment with either CFC-or HFA-fluticasone. 111 This is in line with results of 2 further real-life cross-sectional studies showing that the use of extrafine-particle HFA-beclomethasone/formoterol was associated with a higher percentage of patients with wellcontrolled asthma based on their Asthma Control Test and ACQ scores than the use of fluticasone/salmeterol or budesonide/formoterol combination treatment. 112,113 Taken together, these studies show that extrafine-particle pressurized metered-dose inhalers might have additional clinical benefits in the treatment of asthma compared with coarse-particle treatment.…”

Section: Effect Of Asthma Treatment On Small-airways Function and Symsupporting

confidence: 84%

“…[107][108][109][110][111][112][113] Extrafine-particle ICSs with an MMAD of approximately 1 mm have a higher lung deposition (50% to 60%) than coarse particle ICSs with an MMAD of 3 to 4 mm (10% to 20%). [114][115][116] Boulet et al 107 compared 3-month treatment with 320 mg of hydrofluoroalkane (HFA)-ciclesonide administered once daily with 200 mg of dry powder inhaler (DPI)-fluticasone administered twice daily in patients with asthma.…”

Section: Effect Of Asthma Treatment On Small-airways Function and Symmentioning

confidence: 99%

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Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review

Wiel

Hacken

Postma

et al. 2013

Journal of Allergy and Clinical Immunology

161

100

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Section: Effect Of Asthma Treatment On Small-airways Function and Symsupporting

confidence: 84%

Section: Effect Of Asthma Treatment On Small-airways Function and Symmentioning

confidence: 99%

Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review

Wiel

Hacken

Postma

et al. 2013

Journal of Allergy and Clinical Immunology

161

100

View full text Add to dashboard Cite

“…[1–3] An advantage of small-particle instead of large-particle inhaled treatment could be a higher total lung deposition in addition to better deposition in the small airways. [4,5] Yet, we are currently not able to select asthma patients with small airway dysfunction, i.e.…”

Section: Introductionmentioning

confidence: 99%

Targeting the small airways with dry powder adenosine: a challenging concept

Wiel

Lexmond

Berge

et al. 2017

European Clinical Respiratory Journal

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Background: Small-particle inhaled corticosteroids (ICS) provide a higher small airway deposition than large-particle ICS. However, we are still not able to identify asthma patients who will profit most from small-particle treatment. Objective: We aimed to identify these patients by selectively challenging the small and large airways. We hypothesized that the airways could be challenged selectively using small- and large-particle adenosine, both inhaled at a high and a low flow rate. Design: In this cross-over study 11 asthma subjects performed four dry powder adenosine tests, with either small (MMAD 2.7 µm) or large (MMAD 6.0 µm) particles, inhaled once with a low flow rate (30 l min–1) and once with a high flow rate (60 l min–1). Spirometry and impulse oscillometry were performed after every bronchoprovocation step. We assumed that FEV1 reflects the large airways, and FEF25–75%, R5-R20 and X5 reflect the small airways. Results: The four adenosine tests were not significantly different with respect to the threshold values of FEV1 (p = 0.12), FEF25–75% (p = 0.37), R5-R20 (p = 0.60) or X5 (p = 0.46). Both small- and large-particle adenosine induced a response in the small airways in the majority of the tests. Conclusions: In contrast to our hypothesis, all four adenosine tests provoked a response in the small airways and we could not identify different large- or small-airway responders. Interestingly, even the test with large particles and a high flow rate induced a small-airway response, suggesting that selective challenging of the small airways is not necessary. Future studies should investigate the relation between particle deposition and the site of an airway response.

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“…Several prospective randomised controlled trials have shown greater improvements in small airway outcomes in response to extra-fine compared with coarse particle ICS formulations in unselected patient cohorts [8][9][10][11][12]. Other retrospective health informatics data comparing extra-fine and coarse particle ICS formulations have revealed consistent results in terms of improved asthma control based on prescribing outcomes, but have not measured any small airway pulmonary function outcomes [13][14][15]. We believe the time has now come for designing prospective randomised controlled trials enrolling patients with an enriched small airway phenotype, perhaps powered on pragmatic outcomes such as the Asthma Control Questionnaire.…”

mentioning

confidence: 99%

Small airway dysfunction is associated with poorer asthma control

et al. 2014

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The clinical relevance of the small airways in persistent asthma has been gaining greater recognition in recent years [1]. Studies have shown that a significant proportion of asthmatics on standard treatment fail to achieve satisfactory asthma control. For example, in one study of 3421 asthmatic subjects who underwent guideline-driven dose titration with standard inhaled corticosteroids (ICS)/long-acting b-agonist (LABA) combination therapy over 1 year, only 41% achieved total control of their asthma while 71% were well controlled [2]. ANDERSON et al. [3] found a high prevalence of adult patients with persistent small airway dysfunction determined by impulse oscillometry (IOS) (assessed as the difference between the resistance at 5 Hz (R5) and that at 20 Hz oscillation (R20)) and spirometry (assessed as the forced expiratory flow at 25-75% of forced vital capacity (FEF25-75%)) across British Thoracic Society (BTS) treatment steps for asthma, many of whom had a preserved forced expiratory volume in 1 s (FEV1). This, in turn, suggests an unmet clinical need in terms of patients who may have a small airway asthma phenotype.We therefore evaluated whether small airway dysfunction was associated with worse control in adult asthmatics with a preserved FEV1 (.80% predicted). Spirometry and IOS measurements from unselected asthmatics referred from primary care who attended screening for clinical trials were linked to prescription data. The prescription data were obtained from the Tayside Health Informatics Centre (Dundee, UK), which links all community-dispensed prescriptions using a person's unique identifier, the Community Health Index. Spirometry and IOS measurements from asthmatics were linked to oral corticosteroid and short-acting b-agonist (SABA) use. We evaluated whether small airway dysfunction, defined as FEF25-75% ,70%, or peripheral airway resistance, defined as R5-R20 .0.07 kPa?L -1 ?s, was associated with increased oral corticosteroid and SABA use. Oral steroid and SABA use 1 year prior and 1 year following the index measurements were determined, i.e. whether or not patients had an oral steroid prescription for an asthma exacerbation, or the use of more than four, or four or fewer SABA inhalers. Research ethics committee approval was obtained for all the studies for which the patients were being screened, and Caldicott Guardian approval was obtained to transfer the data to the Health Informatics Centre. IOS (Masterscreen IOS; Jaeger, Hochberg, Germany) was performed in triplicate in accordance with the manufacturer's guidelines. A SuperSpiro spirometer (Micro Medical Ltd, Chatham, UK) was used in triplicate in accordance with European Respiratory Society guidelines [4]. Logistic regression analysis was applied to calculate the odds ratios for steroid and salbutamol use in the different groups. Age, sex, ICS, LABA and leukotriene receptor antagonists (LTRA) use were all included as covariates to calculate the adjusted odds ratio and 95% confidence interval.

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Prescribing practices and asthma control with hydrofluoroalkane-beclomethasone and fluticasone: A real-world observational study

Cited by 69 publications

References 34 publications

Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review

Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review

Targeting the small airways with dry powder adenosine: a challenging concept

Small airway dysfunction is associated with poorer asthma control

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