Asthma patients, who remain symptomatic despite treatment with inhaled corticosteroids/long-acting β2 agonists may be prescribed single-inhaler triple therapy as short-term treatment. To investigate factors that would predict a beneficial response with single-inhaler triple therapy in patients with asthma, researchers from Japan enrolled 45 patients in a retrospective study.¹ These patients had been prescribed the single-inhaler triple therapy from March 2019 to March 2021. Predictors of responsiveness to 4 weeks of therapy were assessed. The demographic information along with data about residual respiratory symptoms, type 2 biomarkers and pulmonary function prior to the use of SITT was obtained from the medical records of the patients.

Three-fourth (75%) of the enrolled patients were found to respond to the short-term treatment with triple therapy single-inhaler. Patients who did not respond to the inhaler therapy had significantly lower forced vital capacity (FVC) (%predicted) values and experienced dyspnea more often than responders. The type 2 biomarkers (sputum and blood eosinophils, exhaled nitric oxide levels and serum periostin) were comparable between the two groups.

Factors found to be predictors of poor or no response to SITT were residual dyspnea, low FVC (%predicted) and FVC (%predicted) < 80% with odds ratios (OR) of 0.14, 1.05 and 0.11, respectively. On multivariate analysis, residual dyspnea prior to being prescribed the inhaler therapy was associated with poor response to SITT (OR 0.14). Patients with residual dyspnea also had significantly lower FEF25-75 (%predicted) values compared to patients who did not have residual dyspnea before the use of SITT.

At least 75% of the patients responded to short-term treatment with the single inhaler triple therapy in this study; this effect was independent of the demographics or type 2 phenotype. Residual dyspnea, indicative of small airways dysfunction, therefore may be predictive of poor response to inhaler therapy in these patients, as shown in this study.

Reference

1. Ito K, et al. Residual dyspnea may predict small airways dysfunction and poor responsiveness to single-inhaler triple therapy in asthmatic patients. Am J Respir Crit Care Med 2023;207:A1299. https://doi.org/10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A1299.