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Pragmatic evaluation of inhaled corticosteroid particle size formulations on asthma control
Author(s) -
Kuo Chris RuiWen,
Jabbal Sunny,
Anderson William,
Lipworth Brian J.
Publication year - 2019
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.13453
Subject(s) - medicine , asthma , corticosteroid , minimal clinically important difference , quality of life (healthcare) , lung function , pulmonary function testing , beclometasone dipropionate , anesthesia , lung , respiratory disease , randomized controlled trial , nursing
Background Extra‐fine particle formulations of inhaled corticosteroid (ICS) are associated with improved lung delivery. Objectives A pragmatic study to assess patient‐reported outcomes after switching from fine to extra‐fine particle ICS in persistent asthma. Methods Twenty‐four patients (mean age 48 year, FEV 1 84%, ACQ 1.67) received 4 weeks run‐in with a constant dose of fine particle ICS (mean dose 710 µg), followed by switching to an equivalent dose of extra‐fine particle hydrofluoroalkane beclomethasone dipropionate (mean dose 355µg). Asthma control questionnaire (ACQ), the primary outcome and mini asthma quality of life questionnaire (mAQLQ) were measured pre‐ and post‐run‐in (baseline) and after 4 weeks and 8 weeks of switching. Results Comparing pre‐ vs post‐run‐in, there were no differences for ACQ: 1.67 vs 1.65 or AQLQ: 5.08 vs 5.34. There were mean (95%CI) improvements ( P < 0.001) from baseline after 8 weeks for ACQ: −0.53 (−0.83, −0.23) and AQLQ: 0.69 (0.35, 1.04), which exceeded the minimal clinically important difference (MCID) of 0.5 for both. There were also differences ( P < 0.05) in domiciliary symptoms and reliever use. There were no significant changes at 8 weeks in lung function, FeNO or blood eosinophils. Conclusions Pragmatic switching from fine to extra‐fine particle ICS at half the dose was associated with clinically relevant improvements in asthma control and quality of life, but not lung function or type 2 biomarkers.