Effect of inhaled corticosteroid particle size on asthma efficacy and safety outcomes: a systematic literature review and meta-analysis

Baou, Céline El; L., Di Santostefano, Rachael; Alfonso-Cristancho, Rafael; Suarez, Elizabeth A.; Stempel, David A.; Everard, Mark L.; Barnes, Neil

doi:10.1186/s12890-016-0348-4

Cited by 22 publications

(23 citation statements)

References 44 publications

(55 reference statements)

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“…Baou EL reported that in a meta-analysis of studies on patients with asthma, no significant differences were observed between smaller size and larger standard size particle of ICS for change in spirometry. Although there was a relationship between smaller particle size and increased delivery to the distal lung, increased deposition in the distal lung did not improve the clinical outcomes in patients with asthma [32]. On the other hand, this study indicated that there may be a certain relationship between the site of airway impairment and the particle size of ICS.…”

Section: Discussioncontrasting

confidence: 61%

A retrospective analysis of usefulness of impulse oscillometry system in the treatment of asthma

et al. 2020

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Background: Bronchial asthma (BA) has different phenotypes, and it requires a clinically effective subtype classification system. The impulse oscillometry system (IOS) is an emerging technique device used in respiratory functional tests. However, its efficacy has not been validated. Therefore, this study aimed to assess the relationship between BA and the IOS parameters, and the difference in the therapeutic effects of inhaled corticosteroids (ICSs) among the subtype classifications was evaluated using the IOS. Methods: Of the 245 patients with bronchial asthma who were screened, 108 were enrolled in this study. These patients were divided based on three subtypes according to the IOS result as follows: central predominant type (n = 34), peripheral predominant type (n = 58), and resistless type (n = 16). Then, the following ICSs were randomly prescribed in daily medical care: coarse-particle ICS (fluticasone propionate [FP]), fine-particle ICS (mometasone furoate [MF]), and moderate-particle ICS (budesonide [BUD]). The treatment effects were assessed using the Asthma Health Questionnaire (AHQ) and the Asthma Control Test (ACT) and were compared among the three subtypes. Results: In the central predominant type, the AHQ score of the MF group was significantly higher than that of the FP group (15.4 vs. 3.6, p < 0.01) and the BUD group (15.4 vs. 8.8, p < 0.05); the ACT score of the FP group was significantly higher than that of the MF and BUD groups (24.3 vs. 21.7, 22.3, respectively, p < 0.05) at 4 weeks after treatment. In the peripheral predominant type, the AHQ score of the FP group was significantly higher than that of the MF group (14.1 vs. 3.4, p < 0.05); the ACT score of the FP group was lower than that of the MF and BUD groups (22.8 vs. 24.6, 24.4, respectively, p < 0.01) at 4 weeks after treatment. Conclusions: An association was observed between IOS subtype classification and ICS particle size in terms of therapeutic efficacy in BA. This result indicates that the IOS could be an effective tool in the selection of ICS and the evaluation of the BA phenotype.

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Section: Discussioncontrasting

confidence: 61%

A retrospective analysis of usefulness of impulse oscillometry system in the treatment of asthma

et al. 2020

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“…Baou EL reported that in a meta-analysis of studies on patients with asthma, no signi cant differences were observed between smaller size and larger standard size particle of ICS for change in spirometry. Although there was a relationship between smaller particle size and increased delivery to the distal lung, increased deposition in the distal lung did not improve the clinical outcomes in patients with asthma [32]. On the other hand, this study indicated that there may be a certain relationship between the site of airway impairment and the particle size of ICS.…”

Section: Discussioncontrasting

confidence: 61%

A retrospective analysis of usefulness of impulse oscillometry system in the treatment of asthma

Sugawara¹,

Saito

Yokoyama

et al. 2020

Preprint

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Abstract Background: Bronchial asthma (BA) has different phenotypes, and it requires a clinically effective subtype classification system. The impulse oscillometry system (IOS) is an emerging technique device used in respiratory functional tests. However, its efficacy has not been validated. Therefore, this study aimed to assess the relationship between BA and the IOS parameters, and the difference in the therapeutic effects of inhaled corticosteroids (ICSs) among the subtype classifications was evaluated using the IOS.Methods: Of the 245 patients with bronchial asthma who were screened, 108 were enrolled in this study. These patients were divided based on three subtypes according to the IOS result as follows: central predominant type (n = 34), peripheral predominant type (n = 58), and resistless type (n = 16). Then, the following ICSs were randomly prescribed in daily medical care: coarse-particle ICS (fluticasone propionate [FP]), fine-particle ICS (mometasone furoate [MF]), and moderate-particle ICS (budesonide [BUD]). The treatment effects were assessed using the Asthma Health Questionnaire (AHQ) and the Asthma Control Test (ACT) and were compared among the three subtypes.Results: In the central predominant type, the AHQ score of the MF group was significantly higher than that of the FP group (15.4 vs. 3.6, p < 0.01) and the BUD group (15.4 vs. 8.8, p < 0.05); the ACT score of the FP group was significantly higher than that of the MF and BUD groups (24.3 vs. 21.7, 22.3, respectively, p < 0.05) at 4 weeks after treatment. In the peripheral predominant type, the AHQ score of the FP group was significantly higher than that of the MF group (14.1 vs. 3.4, p < 0.05); the ACT score of the FP group was lower than that of the MF and BUD groups (22.8 vs. 24.6, 24.4, respectively, p < 0.01) at 4 weeks after treatment. In the resistless type, no significant difference was observed in the both scores among the three groups. Conclusions: An association was observed between IOS subtype classification and ICS particle size in terms of therapeutic efficiency in BA. This result indicates that the IOS could be an effective tool in the selection of ICS and the evaluation of the BA phenotype.

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“…6 Altering the pattern of particle size distribution, even within this small range, can influence the deposition characteristics of an aerosol. 26…”

Section: Technical Factors To Consider When Selecting An Inhaler Devicementioning

confidence: 99%

What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape

Lavorini

Janson

Braido

et al. 2019

Ther Adv Respir Dis

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Inhaled therapies are the cornerstone of treatment in asthma and chronic obstructive pulmonary disease, and there are a multitude of devices available. There is, however, a distinct lack of evidence-based guidance for healthcare providers on how to choose an appropriate inhaler. This review aims to summarise recent updates on topics related to inhaler choice, and to offer practical considerations for healthcare providers regarding currently marketed devices. The importance of choosing the right inhaler for the right patient is discussed, and the relative merits of dry powder inhalers, pressurised metered dose inhalers, breath-actuated pressurised metered dose inhalers, spacers and soft mist inhalers are considered. Compiling the latest studies in the devices therapy area, this review focuses on the most common types of handling errors, as well as the comparative rates of incorrect inhalation technique between devices. The impact of device-specific handling errors on inhaler performance is also discussed, and the characteristics that can impair optimal drug delivery, such as inhalation flow rate, inhalation volume and particle size, are compared between devices. The impact of patient perceptions, behaviours and problems with inhalation technique is analysed, and the need for appropriate patient education is also highlighted. The continued development of technology in inhaler design and the need to standardise study assessment, endpoints and patient populations are identified as future research needs. The reviews of this paper are available via the supplemental material section.

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Effect of inhaled corticosteroid particle size on asthma efficacy and safety outcomes: a systematic literature review and meta-analysis

Cited by 22 publications

References 44 publications

A retrospective analysis of usefulness of impulse oscillometry system in the treatment of asthma

A retrospective analysis of usefulness of impulse oscillometry system in the treatment of asthma

A retrospective analysis of usefulness of impulse oscillometry system in the treatment of asthma

What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape

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