Comparison of extrafine and non-extrafine inhaled corticosteroids/long-acting β-agonists as maintenance and reliever therapy in asthma: a randomized open-label crossover trial
Background/Aims Asthma is characterized by chronic inflammation. Inhaled corticosteroids (ICS) remain the cornerstone of anti-inflammatory therapy, targeting both the large and small airways. Methods This randomized open-label crossover trial included 30 patients receiving step 3 inhaled medication...
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The Korean Association of Internal Medicine
2025-05-01
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| Series: | The Korean Journal of Internal Medicine |
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| Online Access: | http://kjim.org/upload/kjim-2024-393.pdf |
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| author | Sang Pyo Lee Sang Min Lee Sung-Yoon Kang |
| author_facet | Sang Pyo Lee Sang Min Lee Sung-Yoon Kang |
| author_sort | Sang Pyo Lee |
| collection | DOAJ |
| description | Background/Aims Asthma is characterized by chronic inflammation. Inhaled corticosteroids (ICS) remain the cornerstone of anti-inflammatory therapy, targeting both the large and small airways. Methods This randomized open-label crossover trial included 30 patients receiving step 3 inhaled medication according to the Global Initiative for Asthma (GINA). Patients received beclomethasone/formoterol (BDP/F) for maintenance and reliever therapy for 6 weeks, followed by budesonide/formoterol (BUD/F) for 6 weeks, or vice versa, with a 4-week washout period in between. Assessments at each visit included the Asthma Control Test (ACT), Asthma Control Questionnaire, Quality of Life Questionnaire for Adult Korean Asthmatics, and pulmonary function test. The primary endpoint was the change in forced expiratory flow between 25% and 75% of vital capacity (FEF25–75% pred). Results Twenty-four patients (15 females, mean age 39.3 years) completed the study. The changes in FEF25–75% pred were comparable between BDP/F and BUD/F (5.79 ± 38.34 vs. −1.36 ± 14.93, p = 0.399). No significant differences were observed between the BDP/F and BUD/F groups in terms of improvement in asthma control or quality of life. However, in the subgroup of patients with positive methacholine bronchial provocation tests, BDP/F significantly improved ACT scores compared to BUD/F (0.92 ± 2.25 vs. −1.31 ± 3.04, p = 0.044). Conclusions Our study demonstrated that extrafine ICS treatment provided no significant advantage over non-extrafine ICS in improving small airway obstruction or overall asthma control in moderate asthma. This suggests that factors other than particle size may contribute to treatment outcomes. |
| format | Article |
| id | doaj-art-56fede14d4bf4ad2bfec7fe92202d086 |
| institution | Kabale University |
| issn | 1226-3303 2005-6648 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | The Korean Association of Internal Medicine |
| record_format | Article |
| series | The Korean Journal of Internal Medicine |
| spelling | doaj-art-56fede14d4bf4ad2bfec7fe92202d0862025-08-20T03:48:10ZengThe Korean Association of Internal MedicineThe Korean Journal of Internal Medicine1226-33032005-66482025-05-0140349150110.3904/kjim.2024.393171023Comparison of extrafine and non-extrafine inhaled corticosteroids/long-acting β-agonists as maintenance and reliever therapy in asthma: a randomized open-label crossover trialSang Pyo Lee0Sang Min Lee1Sung-Yoon Kang2 Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea Division of Respiratory Disease and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, KoreaBackground/Aims Asthma is characterized by chronic inflammation. Inhaled corticosteroids (ICS) remain the cornerstone of anti-inflammatory therapy, targeting both the large and small airways. Methods This randomized open-label crossover trial included 30 patients receiving step 3 inhaled medication according to the Global Initiative for Asthma (GINA). Patients received beclomethasone/formoterol (BDP/F) for maintenance and reliever therapy for 6 weeks, followed by budesonide/formoterol (BUD/F) for 6 weeks, or vice versa, with a 4-week washout period in between. Assessments at each visit included the Asthma Control Test (ACT), Asthma Control Questionnaire, Quality of Life Questionnaire for Adult Korean Asthmatics, and pulmonary function test. The primary endpoint was the change in forced expiratory flow between 25% and 75% of vital capacity (FEF25–75% pred). Results Twenty-four patients (15 females, mean age 39.3 years) completed the study. The changes in FEF25–75% pred were comparable between BDP/F and BUD/F (5.79 ± 38.34 vs. −1.36 ± 14.93, p = 0.399). No significant differences were observed between the BDP/F and BUD/F groups in terms of improvement in asthma control or quality of life. However, in the subgroup of patients with positive methacholine bronchial provocation tests, BDP/F significantly improved ACT scores compared to BUD/F (0.92 ± 2.25 vs. −1.31 ± 3.04, p = 0.044). Conclusions Our study demonstrated that extrafine ICS treatment provided no significant advantage over non-extrafine ICS in improving small airway obstruction or overall asthma control in moderate asthma. This suggests that factors other than particle size may contribute to treatment outcomes.http://kjim.org/upload/kjim-2024-393.pdfasthmabeclomethasonebudesonideforced expiratory flow between 25% and 75% of vital capacitytreatment outcome |
| spellingShingle | Sang Pyo Lee Sang Min Lee Sung-Yoon Kang Comparison of extrafine and non-extrafine inhaled corticosteroids/long-acting β-agonists as maintenance and reliever therapy in asthma: a randomized open-label crossover trial The Korean Journal of Internal Medicine asthma beclomethasone budesonide forced expiratory flow between 25% and 75% of vital capacity treatment outcome |
| title | Comparison of extrafine and non-extrafine inhaled corticosteroids/long-acting β-agonists as maintenance and reliever therapy in asthma: a randomized open-label crossover trial |
| title_full | Comparison of extrafine and non-extrafine inhaled corticosteroids/long-acting β-agonists as maintenance and reliever therapy in asthma: a randomized open-label crossover trial |
| title_fullStr | Comparison of extrafine and non-extrafine inhaled corticosteroids/long-acting β-agonists as maintenance and reliever therapy in asthma: a randomized open-label crossover trial |
| title_full_unstemmed | Comparison of extrafine and non-extrafine inhaled corticosteroids/long-acting β-agonists as maintenance and reliever therapy in asthma: a randomized open-label crossover trial |
| title_short | Comparison of extrafine and non-extrafine inhaled corticosteroids/long-acting β-agonists as maintenance and reliever therapy in asthma: a randomized open-label crossover trial |
| title_sort | comparison of extrafine and non extrafine inhaled corticosteroids long acting β agonists as maintenance and reliever therapy in asthma a randomized open label crossover trial |
| topic | asthma beclomethasone budesonide forced expiratory flow between 25% and 75% of vital capacity treatment outcome |
| url | http://kjim.org/upload/kjim-2024-393.pdf |
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