Department of Pulmonology, The Calcutta Medical Research Institute, Kolkata 700088, India.
Metro Respiratory Center, Pulmonology & Sleep Medicine, Metro Hospitals & Heart Institute, Noida 201301, India.
Adv Respir Med. 2022 Sep 29;90(5):407-424. doi: 10.3390/arm90050051.
Inhaled corticosteroid and ultra-long-acting beta-agonist (ICS/uLABA) combination is a recent advancement in the armamentarium against obstructive airways diseases (OADs). The combination of ICS/uLABA has several advantages, creating a favorable landscape for its utilization. Fluticasone furoate/vilanterol trifenatate (FF/Vi) is one such example of an ICS/uLABA. It offers several benefits from both drugs, such as a convenient once daily dosing schedule; high lipophilicity; high receptor affinity of fluticasone furoate along with high functional selectivity and a quick onset of action of vilanterol. However, the Global Initiative for Asthma (GINA) as well as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines do not clearly define the positioning of ICS/uLABA compared to conventional ICS/LABAs. There are a few areas of uncertainty especially around the appropriate reliever strategy with ICS/uLABA in Asthma. The current consensus was planned with a group of Indian pulmonology experts to provide more clarity on the potential use of FF/Vi in Asthma and COPD. The clinical statements highlighted in this consensus manuscript address crucial clinical questions revolving around the efficacy and safety of FF/Vi as compared to conventional ICS/LABAs and identify the ideal patient profile for its use. This consensus paper also sheds light upon the appropriate reliever to be used along with FF/Vi in Asthma and the utilization of FF/Vi-based triple therapy in OADs. Expert recommendations mentioned in this paper will serve as guidance to pulmonologists as well as consultant physicians who are involved in providing care to OAD patients and will help them weigh the various factors that need to be taken into account while prescribing ICS/uLABA combination.
吸入性皮质类固醇和长效β-激动剂（ICS/uLABA）联合治疗是治疗气道阻塞性疾病（OADs）的最新进展。ICS/uLABA 联合治疗具有多种优势，为其应用提供了有利条件。糠酸氟替卡松/维兰特罗三苯乙酸酯（FF/Vi）就是 ICS/uLABA 的一个例子。它结合了两种药物的优点，例如方便的每日一次给药方案；高亲脂性；糠酸氟替卡松的高受体亲和力以及维兰特罗的高功能选择性和快速作用。然而，全球哮喘倡议（GINA）和慢性阻塞性肺疾病全球倡议（GOLD）指南并没有明确界定 ICS/uLABA 与传统 ICS/LABA 的定位。在哮喘中，特别是在 ICS/uLABA 的适当缓解剂策略方面，存在一些不确定性。目前，计划由一组印度肺病专家制定共识，以提供更多关于 FF/Vi 在哮喘和 COPD 中潜在用途的信息。本共识文件中强调的临床陈述围绕 FF/Vi 与传统 ICS/LABA 相比的疗效和安全性提出了关键的临床问题，并确定了其使用的理想患者特征。本共识文件还阐明了在哮喘中与 FF/Vi 一起使用的适当缓解剂以及在 OAD 中使用基于 FF/Vi 的三联疗法。本文中的专家建议将为参与 OAD 患者护理的肺病专家和顾问医生提供指导，并帮助他们权衡在开具 ICS/uLABA 联合治疗时需要考虑的各种因素。
