Affiliation:
1. Russian Medical Academy of Continuing Professional Education
Abstract
Bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases of the airways. Inhaled bronchodilators and corticosteroids are the cornerstone of pharmacological long-term treatment for asthma and COPD. The efficacy of any topical inhaled medication is dependent upon successful distribution of the drug to the site of disease. Targeting small airways inflammation in severe asthma and COPD are critically important as the combined surface area of small airways far exceeds the surface area that large central airways provide. Small airway dysfunction in BA is associated with increased asthma symptoms, worse asthma control and an increased number of exacerbations. Chronic inflammation in COPD causes structural alterations and narrowing of particularly the small airways. The extrafine combination of beclomethasone dipropionate/formoterol (BDP/F) enables drug delivery to both the large and small airways, and allows the clinical benefits to be achieved with a lower corticosteroid dose. The use of extrafine BDP/F is more effective in achievement asthma control and reduce COPD exacerbations. If it is necessary to continue ICS as part of a double or triple COPD therapy extrafine fixed combination of BDP/F can be considered as the drug of choice and optimal replacement of the ICS molecule.
Reference50 articles.
1. Barnes P.J. Cellular and molecular mechanisms of asthma and COPD. Clin Sci (Lond). 2017;131(13):1541–1558. doi: 10.1042/CS20160487.
2. Chuchalin A.G., Avdeev S.N., Aysanov Z.R., Belevskiy A.S., Vasileva O.S., Geppe N.A. et al. Bronhialnaya astma. Federalnyie klinicheskie rekomendatsii = Bronchial asthma. Federal Clinical Guidelines. Moscow; 2019. 97 р. (In Russ.) Available at: https://www.spulmo.ru/upload/kr_bronhastma_2019.pdf.
3. Price D., Fletcher M., van der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014;24:14009. doi: 10.1038/npjpcrm.2014.9.
4. Carr T.F., Altisheh R., Zitt M. Small airways disease and severe asthma. World Allergy Organ J. 2017;10(1):20. doi: 10.1186/s40413-017-0153-4.
5. Chapman K.R., Boulet L.P., Rea R.M., Franssen E. Suboptimal asthma control: prevalence, detection and consequences in general practice. Eur Respir J. 2008;31(2):320–325. doi: 10.1183/09031936.00039707.