The new prospects of the inhalation therapy for bronchial asthma

2020 ◽  
Vol 30 (4) ◽  
pp. 473-484
Author(s):  
S. N. Avdeev ◽  
Z. R. Aisanov
Keyword(s):  
Clinical Trials ◽  
Bronchial Asthma ◽  
Randomized Clinical Trials ◽  
Inhaled Corticosteroids ◽  
Fixed Combination ◽  
Inhalation Therapy ◽  
International Literature ◽  
Dosing Regimen ◽  
Muscarinic Antagonist ◽  
Long Acting

Based on the latest new international literature data, the article considers the possibilities of fixed combinations of long-acting β2-agonist, long-acting muscarinic antagonist and inhaled corticosteroids in achieving the control of bronchial asthma (BA). Clinical advantages for a fixed combination of indacaterol, glycopyrronium and mometasone furoate one dosing regimen in the therapy of BA are presented based on the results of recently completed randomized clinical trials IRIDIUM and ARGON.

scholarly journals Tiotropium bromide: additional options for the treatment of bronchial asthma

2019 ◽  
Vol 16 (3) ◽  
pp. 67-74
Author(s):  
O M Kurbacheva ◽  
M E Dyneva
Keyword(s):  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Biological Properties ◽  
Additional Treatment ◽  
Tiotropium Bromide ◽  
Inhalation Therapy ◽  
Global Initiative For Asthma ◽  
Successful Control ◽  
Global Initiative ◽  
Long Acting

Bronchial asthma (BA) is one of the most common chronic diseases, characterized by airway inflammation and bronchospasm. Symptoms of BA are wheezing, shortness of breath, a feeling of constriction in the chest and cough, the frequency and severity of which vary greatly over time. Today studies of BA phenotypes allow selecting treatment depending on the particular pathogenesis of each phenotype individually, thereby helping to achieve control, which is the main goal of BA therapy. However, it is necessary to take into account the peculiarities of airway innervation, since an increased parasympathetic tone is characteristics of all BA phenotypes and plays an important role in the development of bronchoconstriction and inflammation. Therefore, tiotropium bromide, which is a long-acting blocker of muscarinic cholinergic receptors, is one of the main bronchodilators in the treatment of BA. It blocks bronchoconstriction, hypersecretion and swelling of the mucous membrane of the airway, which in turn prevents the progression of inflammation, and the prolonged action of tiotropium bromide, which allows it to be used once a day helps to achieve control of asthma in addition to basic inhalation therapy - inhaled corticosteroids (ICS) long-acting P2-agonists (LABA). According to GINA (Global Initiative for Asthma), tiotropium bromide is recommended as an additional treatment, starting from step 4, and in accordance with the Russian Federal Clinical Guidelines for Bronchial Asthma - from step 3. Currently, according to clinical studies, much is known about the mechanisms of action and biological properties of tiotropium bromide, which made it possible to substantiate the needs for its administration to patients with BA regardless of its phenotype. This strategy will contribute to a more successful control of BA considering risk factors and comorbidity, thereby reducing needs of increasing ICS dose.

scholarly journals Combined therapy with inhaled glucocorticosteroids and long-acting β2-agonists in patients with bronchial asthma: the problem of choice

2021 ◽  
pp. 52-59
Author(s):  
A. I. Sinopalnikov
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Bronchial Asthma ◽  
Randomized Clinical Trials ◽  
Pathological Condition ◽  
New Combination ◽  
Fluticasone Furoate ◽  
Combination Drug ◽  
Optimal Drug ◽  
Long Acting

Bronchial asthma remains one of the most common chronic respiratory diseases. The apparent heterogeneity of BA underlies the concept of phenotype-specific or patient-centered therapy. However, in real clinical practice, BA continues to be regarded as a rather homogeneous pathological condition and its treatment in the vast majority of cases retains an empirical approach, the basis of which are inhaled glucocorticosteroids, usually in combination with long-acting beta2-agonists. Since this group of drugs is very representative, the physician is faced with the question of choosing the optimal drug. The basis of evidence-based medicine is a hierarchical classification, where systematic reviews, meta-analyses, and randomized clinical trials are considered the highest level of evidence. Because randomized clinical trials are conducted in carefully selected highly selected patient populations, they have little relevance to patients encountered in everyday clinical practice. In contrast, pragmatic randomized clinical trials assess the clinical efficacy of the investigational agent in a large, unselected population in which patients with comorbidities are included. In this context, the Salford Lung Study (SLS) is of particular interest. It was conducted before the registration of a new combination drug containing the modern ICS fluticasone furoate and the long-acting beta2-agonist vilanterol. The SLS results indicated not only that the use of fluticasone furoate with vilanterol provides better control of BA compared to continued "conventional therapy" (ICS ± LABAs) in symptomatic patients, but also leads to a consistent improvement in the surrogate parameters of quality of life.

scholarly journals Tiotropium: efficacy and safety in pediatric bronchial asthma

2021 ◽  
pp. 175-180
Author(s):  
Natalia G. Kolosova ◽  
Irina V. Grebeneva ◽  
Veronika D. Denisova
Keyword(s):  
Children And Adolescents ◽  
Bronchial Asthma ◽  
Adjunctive Therapy ◽  
Randomized Clinical Trials ◽  
Inhaled Corticosteroids ◽  
Symptom Control ◽  
Asthma Treatment ◽  
Efficacy And Safety ◽  
Chronic Lung Diseases ◽  
Long Acting

Bronchial asthma is one of the most common chronic lung diseases observed in children. According to the international and Russian guidelines, the long-term objectives of asthma treatment in children and adolescents are to achieve good symptom control, minimize the risk of asthma exacerbations, reduce hospital admissions, decrease the use of short-acting bronchodilators, reduce restrictions in the airflow and side effects, and ensure that normal activity levels are maintained. The asthma treatment is based on the use of inhaled corticosteroids as a backbone therapy and addition of adjunctive therapy if the disease control is poor or worsening. Tiotropium bromide is the first anticholinergic drug that has been approved for children and adults with poorly controlled asthma and is currently used as a treatment option for moderate to severe bronchial asthma. Randomized clinical trials in children and adolescents with persistent bronchial asthma showed high efficacy and safety of tiotropium. The addition of tiotropium in the form of 2 inhalations of 2.5 μg once a day to the bronchial asthma therapy in children over 6 years old, including medium doses of inhaled corticosteroids, is a preferred and safe option to increase the therapy coverage compared to an increase of a dose of inhaled corticosteroids to high levels, regardless of the disease phenotype (In atopic, non-atopic bronchial asthma, bronchial asthma with obesity, etc.). Tiotropium adjunctive therapy may also be a therapeutic option for children using inhaled corticosteroids, who have asthma that does not respond well to long-acting β2-agonist therapy, or for those, who are worried about the safety of long-acting β2-agonists.

Current opportunities of inhaled corticosteroid therapy in patients with chronic obstructive pulmonary disease

2021 ◽  
Vol 31 (1) ◽  
pp. 75-87
Author(s):  
I. V. Leshchenko ◽  
A. S. Meshcheryakova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Fixed Combination ◽  
Chronic Obstructive ◽  
Delivery Device ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Long Acting ◽  
Blood Eosinophils

Chronic obstructive pulmonary disease (COPD) is the leading cause of death in the structure of respiratory diseases. The problem of rational pharmacotherapy of COPD have attracted attention of the medical scientific society for many years. The understanding of the pathogenesis of the disease has deepened and approaches to the therapy have changed. Some COPD patients need regular fixed-combination therapy: long-acting bronchodilators (LABD) and inhaled corticosteroids (ICS) in order to prevent exacerbations and reduce the severity of symptoms of the disease. Blood eosinophils count is one of criteria for choosing regular therapy. The appearance of fixed triple combinations of ICS/LABD increased the effectiveness of COPD therapy, and a new delivery device for fixed combination of budesonide/formoterol makes it possible to use ICS successfully in the most severe patients.

Asthma: Anti-Immunoglobulin E Therapy with Omalizumab for Asthma

2007 ◽  
Vol 41 (9) ◽  
pp. 1397-1410 ◽  
Author(s):  
Leslie Hendeles ◽  
Christine A Sorkness
Keyword(s):  
Clinical Trials ◽  
Cost Effectiveness ◽  
Randomized Clinical Trials ◽  
Inhaled Corticosteroids ◽  
Immunoglobulin E ◽  
Data Extraction ◽  
Symptom Control ◽  
High Dose ◽  
Search Term ◽  
Ige Mediated

Objective: To evaluate data on anti-immunoglobulin E (anti-IgE) therapy for asthma. Data Sources: Information was selected from PubMed from 1989 to May 2007 using the search term omalizumab and included randomized, controlled trials. These studies evaluated asthma treatment with omalizumab and focused on its efficacy, tolerability, and cost-effectiveness in this population. Study Selection and Data Extraction: All randomized clinical trials were reviewed (23 were identified and 19 were included; 3 were not relevant and 1 contained duplicative data). Other articles using the search words anti-IgE therapy and cost-effectiveness were evaluated; relevant information was extracted. Data Synthesis: IgE-dependent mechanisms play an important role in the development and maintenance of airway inflammation in asthma. Omalizumab is a subcutaneously administered monoclonal anti-IgE antibody that reduces unbound IgE concentrations and promotes down-regulation of IgE receptors. Results from clinical trials in adults, adolescents, and children with poorly controlled IgE-mediated asthma have shown that omalizumab improves symptom control and allows patients to be managed with lower doses of inhaled corticosteroids (ICS). It has been well tolerated in clinical trials lasting as long as 52 weeks, but injection-site reactions are common (45% in omalizumab group vs 43% in placebo group) and anaphylaxis has occurred in 0.2% of patients. A consensus expert panel has recommended that omalizumab should be considered for patients 12 years of age or older with allergic asthma who are inadequately controlled on guideline-based therapy and require maintenance therapy with systemic corticosteroids or high-dose ICSs, or who have poor adherence to ICS therapy. Conclusions: Anti-IgE therapy provides an effective and generally safe approach to the treatment of patients with IgE-mediated asthma who are not adequately controlled by conventional guideline-based medications. However, the potential benefit must be weighed against the cost and inconvenience of this new therapy.

scholarly journals THE EFFICACY AND SAFETY OF FOSTER IN PATIENTS WITH BRONCHIAL ASTHMA IN ROUTINE CLINICAL PRACTICEon behalf of the Research Group «ESTAFETA» to assess the efficacy and safety of the drug «Foster» in patients with asthma in routine clinical practice

2009 ◽  
Vol 7 (5) ◽  
pp. 82-90
Author(s):  
N I Iljina ◽  
K S Pavlova
Keyword(s):  
Asthma Control ◽  
Bronchial Asthma ◽  
Fixed Combination ◽  
Combined Therapy ◽  
Persistent Asthma ◽  
Innovative Technology ◽  
Symptomatic Therapy ◽  
Efficacy And Safety ◽  
Inhaled Steroids ◽  
Long Acting

Background. Evaluation of the efficacy and safety of the drug Foster (fixed combination of beclomethasone di-propionate 100 mcg and formoterol 6 micrograms per single dose) in metered-dose aerosol inhaler technology Modulite® in patients with bronchial asthma (BA). Methods. Prospective non comparative multicenter open observational study. Study group consisted of 120 practicing physicians from the 92 hospitals in 21 cities of Russia. Analyzed 557 case report forms of patients with moderate persistent asthma treated with Foster during 12 weeks who needed to correct the basic therapy (according to asthma control criteria GINA 2006). Results. The effectiveness of treatment with Foster was observed in 555 (99,6%) of 557 patients, who showed improvement in lung function, decreased severity of symptoms, reducing the need for symptomatic therapy compared with baseline and improved asthma control in general. Conclusions. In most cases, control over moderate and severe persistent asthma can be improved by the combined therapy of inhaled steroids (ICS) and в2-agonist long-acting (LABA). In this case, Foster is a drug of choice with a fixed combination of ICS and LABA. Extra-fine form of the drug (thanks to innovative technology Modulite®) is evenly distributed in central and peripheral airways, providing good therapeutic effect of using of low doses of ICS and reducing the likelihood of side effects.

An Analysis of Potentially Prolactin-Related Adverse Events and Abnormal Prolactin Values in Randomized Clinical Trials with Paliperidone Palmitate

2012 ◽  
Vol 46 (10) ◽  
pp. 1322-1330 ◽  
Author(s):  
Thomas R Einarson ◽  
Michiel EH Hemels ◽  
Isaac Nuamah ◽  
Srihari Gopal ◽  
Danielle Coppola ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Descriptive Statistics ◽  
Paliperidone Palmitate ◽  
Serum Prolactin ◽  
Clinical Trial Database ◽  
Long Acting ◽  
Monthly Dose

Background: Paliperidone palmitate has been associated with serum prolactin elevations in some patients. However, few individuals with elevated prolactin levels (hyperprolactinomia) have symptomatic potentially prolactin-related adverse events (PPR-AEs). Objective: To quantify rates of hyperprolactinemia in subjects treated with the newly marketed paliperidone palmitate long-acting injection (PP-LAI) in randomized clinical trials, summarize rates of PPR-AEs in those trials by sex and dose, and determine how many PPR-AEs required treatment. Methods: Numbers and rates of investigator-reported hyperprolactinemia and PPR-AEs wore obtained from the sponsor's clinical trial database and have been included in regulatory filings. Results were tabulated for males, females, and overall, and by dose administered, using descriptive statistics. Those requiring treatment were described as well. Results: There were 3173 subjects (61.4% males) exposed to PP-LAI in 10 clinical trials; 2831 (89.2%) patients had recorded prolactin levels, including 1759 males (90, 3% of exposed males) and 1072 females (87.5% of exposed females). Overall, at any time, prolactin levels were elevated for 38.8% of the subjects (39.5% for males and 37.7% for females; p = 0.354 between sexes). However, them was no significant correlation between monthly dose and proportion of subjects with elevated prolactin levels (p = 0.109). There were 115 PPR-AEs in 107 patients (3.4%); 51 (44.3% of PPR-AEs) cases represented asymptomatic hyperprolactinemia. The remaining 64 symptomatic PPR-AEs affected 2.0% of the total number of subjects. Fifteen events in 13 participants (0.41% of patients or 4.7 events/1000 patients) required treatment. Conclusions: Clinicians should periodically assess patients on paliperidone palmitate for any PPR-AEs and carefully assess the benefits and risks when managing these effects.

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