Residual Dyspnea May Predict Small Airways Dysfunction and Poor Responsiveness to Single-Inhaler Triple Therapy in Asthmatic Patients

• Published in: Journal of asthma and allergy Vol. 15; pp. 1561 - 1568
• Main Authors: Ito, Keima, Tajiri, Tomoko, Nishiyama, Hirono, Kurokawa, Ryota, Yap, Jenifer Maries Go, Takeda, Norihisa, Fukumitsu, Kensuke, Kanemitsu, Yoshihiro, Fukuda, Satoshi, Uemura, Takehiro, Ohkubo, Hirotsugu, Maeno, Ken, Ito, Yutaka, Oguri, Tetsuya, Takemura, Masaya, Niimi, Akio
• Format: Journal Article
• Language: English
• Published: Macclesfield Dove Medical Press Limited 01.01.2022; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Airway management; Analysis; Asthma; Biomarkers; Blood tests; Body mass index; Chronic obstructive pulmonary disease; Clinical medicine; Comorbidity; Corticosteroids; Demography; Drug dosages; Drug therapy; Dyspnea; Inhalers; long-acting muscarinic antagonists; Medical records; Medical research; Medicine, Experimental; Multivariate analysis; Neutrophils; Original Research; Patients; Regression analysis; Respiration; Respiratory function; single-inhaler triple therapy; small airways dysfunction; Spirometry; Tiotropium; Japan
• ISSN: 1178-6965; 1178-6965
• DOI: 10.2147/JAA.S381953

Purpose: Recently, single-inhaler triple therapy (SITT) has demonstrated efficacy in patients with uncontrolled asthma who were symptomatic despite treatment with inhaled corticosteroids/long-acting [beta]2 agonists. However, the characteristics of patients who benefit from SITT remain unclear in the real-world. The aim of this study was to examine the predictors of responsiveness to SITT in patients with asthma. Patients and Methods: A total of 45 patients with asthma who had regularly visited our respiratory clinic and were started on SITT from March 2019 to March 2021 were retrospectively analyzed. Patients' demographic characteristics, residual respiratory symptoms, type 2 biomarkers, and lung function before SITT were assessed from the patients' medical records. Predictors of responsiveness to four-week SITT were evaluated in these patients. The definition of responders was based on the physician-assessed global evaluation of treatment effectiveness. Results: Thirty-four (75%) of 45 patients were identified as responders to SITT. Non-responders showed significantly lower forced vital capacity (FVC) (%predicted) values, and complained of dyspnea more frequently than responders before SITT (p = 0.01 and p = 0.02, respectively). There were no significant differences in demographic characteristics and type 2 biomarkers between responders and non-responders. Clinical predictors of poor response to SITT were residual dyspnea (OR = 0.14, p = 0.02), low FVC (%predicted) values (OR = 1.05, p = 0.01), and FVC (%predicted) <80% (OR = 0.11, p = 0.02). Multivariate analysis showed that poor response to SITT was associated with residual dyspnea before SITT (OR = 0.14, p = 0.02). On the other hand, patients with residual dyspnea had significantly lower [FEF.sub.25-75] (%predicted) values than patients without residual dyspnea before SITT (p = 0.04). Conclusion: Residual dyspnea, reflecting small airways dysfunction, may predict poor responsiveness to short-term SITT in patients with asthma. Keywords: single-inhaler triple therapy, long-acting muscarinic antagonists, asthma, small airways dysfunction, dyspnea