<p>Triple Therapy with Budesonide/Glycopyrrolate/Formoterol Fumarate Improves Inspiratory Capacity in Patients with Asthma-Chronic Obstructive Pulmonary Disease Overlap</p>

Abstract

Purpose: Asthma-chronic obstructive pulmonary disease overlap (ACO), characterized by airway limitation, is an important condition with high incidence and mortality. Although some guidelines recommend triple therapy with inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β 2 agonists, this treatment approach is based on the extrapolation of data from studies of asthma or chronic obstructive pulmonary disease (COPD) alone. Methods: A 12-week, randomized, open-label cross-over pilot study was conducted in 19 patients with ACO to investigate the effect of triple therapy with glycopyrrolate (GLY) 50 µg/ day on budesonide/formoterol fumarate (BUD/FORM) 640/18 µg/day. The study period included a 4-week wash-out, 4-week run-in, and 4-week treatment period. Respiratory function tests, fractional exhaled nitric oxide (FeNO), a COPD assessment test (CAT) and an asthma control questionnaire (ACQ) were carried out 0, 4, and 8 weeks after randomization. Results: A total of 19 patients with stable ACO (19 males and no females) with a mean age of 70.7 ± 7.6 years (± standard deviation, SD; range 55-83 years) participated in this study. All patients were ex-smokers with a smoking history of 63.1 ± 41.1 pack-years (± SD). Mean values for inspiratory capacity (IC), an index of hyperinflation of the lung that causes exertional dyspnea and reduced exercise, were 1.93 L (± 0.47 L) after the run-in, 1.85 L (± 0.51 L) after the BUD/ FORM dual therapy period and 2.11 L (± 0.58 L) after the BUD/GLY/FORM triple therapy period. IC values after the BUD/GLY/FORM triple therapy were significantly higher than those after the run-in (p < 0.02). FeNO values, ACQ, and CAT scores were not significantly different among the run-in, wash-out, and triple-therapy periods. Conclusion: The present pilot study showed that triple therapy with BUD/GLY/FORM results in an improvement in lung function parameters including IC, indicating the potential value of triple therapy as standard treatment for ACO.

Future Trends in Nebulized Therapies for Pulmonary Disease

“…Another clinical trial is assessing the therapeutic potential of an oxyhydrogen generator delivered by nebulizer to COPD patients (NCT02850185). The combination of LAMA with LABA therapies has proven effective in COPD treatment, several studies showed their efficacy with inhalers [190,193] so delivery by nebulizer may soon be standard. There are also several clinical trials comparing JN versus VMN in COPD patients with some publications already pointing to preference for VMN [194].…”

Tiotropium Add-On and Treatable Traits in Asthma-COPD Overlap: A Real-World Pilot Study

“… 9 , 10 , 19 FM is a LABA with a rapid onset of action and a sustained dose-dependent bronchodilator effect. 11 FP/FM combination therapy via pMDI was reported to be an efficacious treatment option compared with other ICS/LABA combination therapies via DPI even in patients with moderate to severe asthma. 34 , 35 Iwanaga et al also investigated and reported higher drug deposition in the lungs and peripheral airways after FP/FM via pMDI compared with other ICS/LABA combination therapies via DPI.…”

Successful Sequential Treatment for Severe Asthma Coexisting COVID-19 via Budesonide/Glycopyrrolate/Formoterol Fumarate

“…Recently, triple therapy with BGF has been identified effective and convenient among airway diseases as it can result in an improvement in lung function through distinct and complementary mechanisms. 6 BGF might be a good choice as sequential medicine to systemic glucocorticoids in some refractory asthma patients. In present case, BGF help our patient relieve the burden of symptoms as well as daily activities, which greatly enhance the doctors’ confidence of ICS as well as bronchodilators used in COVID-19 complicated with airway disease.…”