A Randomized, Noninferiority Trial Comparing ICS + LABA with ICS + LABA + LAMA in Asthma-COPD Overlap (ACO) Treatment: The ACO Treatment with Optimal Medications (ATOMIC) Study

Park, Soyoung; Kim, Solmi; Kim, Jung-Hyun; Kim, Sae‐Hoon; Lee, Taehoon; Yoon, Sun‐Young; Kim, Min-Hye; Moon, Ji-Yong; Yang, Min‐Suk; Jung, Jae-Woo; Kim, Joohee; Choi, Jeong‐Hee; Park, Chan Sun; Kim, Sujeong; Lee, Jaechun; Kwon, Jae-Woo; Hur, Gyu Young; Kim, Sang-Ha; Kim, Hee-Kyoo; Shin, Yoo Seob; Kim, Sang-Hoon; Nam, Young‐Hee; Jang, An‐Soo; Park, Seo Young; Kim, Tae‐Bum; Song, Woo-Jung; Kwon, Hyouk‐Soo; Cho, You Sook; Moon, Hee‐Bom; Ki, Tae-Bum; Seo, Bomi; Choi, Byoung-Whui; Cho, Young-Joo; Park, So Young; Jin, Hyun Jung; Park, Hye Kyung; Lee, Sang Min; Kang, Sung-Yoon; Ban, Ga‐Young

doi:10.1016/j.jaip.2020.09.066

Cited by 16 publications

(11 citation statements)

References 24 publications

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“…However, first-line triple therapy should be selected for patients with asthma experiencing airflow limitation, such as ACO. [7][8][9][10] Our study did not show that SITT provided a more significant improvement in lung function than SIDT 8 weeks after treatment. In addition, the reducing effects on F E NO after treatment were similar between SITT and SIDT.…”

Section: Discussioncontrasting

confidence: 74%

“…However, the strategies may be permitted as a first-line treatment in patients with asthma and chronic pulmonary obstructive disease (COPD) overlap and asthma with airflow obstructions. [7][8][9][10] Patients with uncontrolled or severe asthma have been a social challenge worldwide [11][12][13] and in Japan. 14 In 2021, the Middle East and North Africa survey using the GINA criteria reported that the percentage of patients with partly controlled and uncontrolled asthma was 29.1% and 41.5%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy and Safety of First-Line Single-Inhaler Triple versus Dual Therapy in Controller-Naïve and Symptomatic Adults with Asthma: A Preliminary Retrospective Cohort Study

Fujiki¹,

Kawayama²,

Furukawa³

et al. 2023

JAA

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Purpose The efficacy and safety of first-line triple and dual therapy remain unclear because the stepwise strategy is a worldwide standard in controller-naïve asthma. A preliminary retrospective cohort study was conducted to investigate the efficacy and safety of first-line triple and dual therapy for managing controller-naïve and symptomatic adult patients with asthma. Patients and Methods Patients with asthma who received first-line single-inhaler triple therapy (SITT) or dual therapy (SIDT) for at least 8 weeks were selected between December 1, 2020, and May 31, 2021, in Fujiki Medical and Surgical Clinic, Miyazaki, Japan. Data on daytime and nighttime visual analog scale (VAS) scores, lung function tests, fractional exhaled nitrogen oxide (F E NO), and adverse events were compared between SITT and SIDT pre- and post-treatment. Results The SITT significantly improved the nighttime, but not daytime, VAS scores better than the SIDT 2 weeks post-treatment ( P = 0.0026), whereas SITT and SIDT significantly improved daytime and nighttime VAS scores after treatment compared to baseline. Both therapies also significantly improved lung functions and F E NO post-treatment. The proportion of patients achieving complete control in the nighttime VAS scores after SITT was significantly higher than that four ( P = 0.0186) and 8 weeks ( P = 0.0061) after SIDT. Only patients with SITT experienced dry mouth. Conclusion Our study demonstrated that first-line SITT and SIDT were effective, and SITT improved disease control faster than SIDT in controller-naïve and symptomatic adult patients with asthma. The first-line SITT may contribute to faster and better control levels in symptomatic patients with asthma.

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Section: Discussioncontrasting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of First-Line Single-Inhaler Triple versus Dual Therapy in Controller-Naïve and Symptomatic Adults with Asthma: A Preliminary Retrospective Cohort Study

Fujiki¹,

Kawayama²,

Furukawa³

et al. 2023

JAA

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“…Additionally, it would be useful to perform a study in a large population of asthma-COPD overlap patients, in which we would expect good effectiveness. Results of the study by Park et al (2021) in this population are promising 40 . Lastly, all studies that have been published about the use of LAMAs in asthma patients demonstrate the effects in a closely monitored experimental setting.…”

Section: Limitations Of Current Studies / Gaps In Our Knowledgementioning

confidence: 67%

Understanding the role of long-acting muscarinic antagonists in asthma treatment

Muiser¹,

Gosens²,

Berge³

et al. 2022

Annals of Allergy, Asthma & Immunology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The only factor associated with a decrease in ACO exacerbation after ICS use was a blood eosinophil count of >/=300 cells/muL [ 82 ]. For the first time, a recent large-scale, multicenter, randomized controlled trial has demonstrated that the addition of long-acting muscarinic antagonist to ICS+long-acting β2-agonist is beneficial for the treatment of ACO patients in terms of lung function improvement but not in exacerbation or symptom control [ 83 ]. Although limited clinical data exist on the efficacy of biological agents in ACO, the Australian Omalizumab Registry’s study suggests that omalizumab, an anti-IgE monoclonal antibody, can improve symptoms and health-related quality of life in individuals with ACO [ 84 , 85 ].…”

Section: Limitations and Perspectives Of Epigenetic-related Investiga...mentioning

confidence: 99%

Unraveling the Pathogenesis of Asthma and Chronic Obstructive Pulmonary Disease Overlap: Focusing on Epigenetic Mechanisms

Chen

Chang

Huang

et al. 2022

Cells

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Asthma and COPD overlap (ACO) is characterized by patients presenting with persistent airflow limitation and features of both asthma and COPD. It is associated with a higher frequency and severity of exacerbations, a faster lung function decline, and a higher healthcare cost. Systemic inflammation in COPD and asthma is driven by type 1 T helper (Th1) and Th2 immune responses, respectively, both of which may contribute to airway remodeling in ACO. ACO-related biomarkers can be classified into four categories: neutrophil-mediated inflammation, Th2 cell responses, arachidonic acid-eicosanoids pathway, and metabolites. Gene–environment interactions are key contributors to the complexity of ACO and are regulated by epigenetic mechanisms, including DNA methylation, histone modifications, and non-coding RNAs. Thus, this review focuses on the link between epigenetics and ACO, and outlines the following: (I) inheriting epigenotypes without change with environmental stimuli, or epigenetic changes in response to long-term exposure to inhaled particles plus intermittent exposure to specific allergens; (II) epigenetic markers distinguishing ACO from COPD and asthma; (III) potential epigenetic drugs that can reverse oxidative stress, glucocorticoid insensitivity, and cell injury. Improved understanding of the epigenetic regulations holds great value to give deeper insight into the mechanisms, and clarify their implications for biomedical research in ACO.

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A Randomized, Noninferiority Trial Comparing ICS + LABA with ICS + LABA + LAMA in Asthma-COPD Overlap (ACO) Treatment: The ACO Treatment with Optimal Medications (ATOMIC) Study

Cited by 16 publications

References 24 publications

The Efficacy and Safety of First-Line Single-Inhaler Triple versus Dual Therapy in Controller-Naïve and Symptomatic Adults with Asthma: A Preliminary Retrospective Cohort Study

The Efficacy and Safety of First-Line Single-Inhaler Triple versus Dual Therapy in Controller-Naïve and Symptomatic Adults with Asthma: A Preliminary Retrospective Cohort Study

Understanding the role of long-acting muscarinic antagonists in asthma treatment

Unraveling the Pathogenesis of Asthma and Chronic Obstructive Pulmonary Disease Overlap: Focusing on Epigenetic Mechanisms

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