Carpagnano Giovanna Elisiana, Portacci Andrea, Dragonieri Silvano, Montagnolo Francesca, Iorillo Ilaria, Lulaj Ernesto, Maselli Leonardo, Buonamico Enrico, Quaranta Vitaliano Nicola
Respiratory Diseases, University of Bari, 70121 Bari, Italy.
J Clin Med. 2024 Apr 17;13(8):2320. doi: 10.3390/jcm13082320.
Several studies have demonstrated the positive clinical and functional impact of adding Long-Acting Muscarinic Antagonist (LAMA) to Inhaled Corticosteroids (ICS) and Long-Acting Beta-Agonists (LABA) therapy in the treatment of severe asthma. Aim and objectives: To demonstrate that treating Small Airways Disease (SAD) in severe asthma patients who are candidates for biologics can improve respiratory symptoms, lung function, and airways inflammation, potentially avoiding or delaying the use of biological therapy. Thirty-two severe asthma patients with SAD were transitioned from separate inhalers for ICS/LABA and LAMA to extrafine single-inhaler beclomethasone, formoterol, and glycopyrronium. None of these patients underwent biological therapy before the study. Follow-up evaluations were conducted at baseline (T0) and three months after initiation (T3). Assessments included clinical evaluations, spirometry, oscillometry, and inflammation markers. Transitioning to single-inhaler triple therapy from T0 to T3 resulted in significant improvements in Asthma Control Test (ACT) and SAD parameters, including increased Forced Expiratory Volume in the mid-range of lung capacity and improved airway resistance and reactance measurements using impulse oscillometry. A significant reduction in airway inflammation was evidenced by lower levels of Fractional Exhaled Nitric Oxide 350 (FeNO 350) ( < 0.001 for all). : Adopting a single-inhaler triple therapy notably enhanced clinical control and small airway function in patients with severe asthma and SAD, supporting the positive impact of target-therapy for the achievement of a stable state termed "Quiet Asthma".
多项研究表明，在重度哮喘治疗中，将长效毒蕈碱拮抗剂（LAMA）添加到吸入性糖皮质激素（ICS）和长效β受体激动剂（LABA）治疗方案中具有积极的临床和功能影响。目的：证明在适合使用生物制剂的重度哮喘患者中治疗小气道疾病（SAD）可改善呼吸症状、肺功能和气道炎症，有可能避免或延迟使用生物治疗。32例患有SAD的重度哮喘患者从用于ICS/LABA和LAMA的单独吸入器转换为倍氯米松、福莫特罗和格隆溴铵超细单吸入器。这些患者在研究前均未接受生物治疗。在基线（T0）和开始治疗三个月后（T3）进行随访评估。评估包括临床评估、肺功能测定、振荡法和炎症标志物。从T0到T3转换为单吸入器三联疗法导致哮喘控制测试（ACT）和SAD参数显著改善，包括肺容量中程用力呼气量增加，以及使用脉冲振荡法测量的气道阻力和电抗改善。呼出一氧化氮分数350（FeNO 350）水平降低证明气道炎症显著减轻（所有均<0.001）。采用单吸入器三联疗法显著增强了重度哮喘和SAD患者的临床控制和小气道功能，支持了靶向治疗对实现称为“安静哮喘”的稳定状态的积极影响。
