Treatment Of Asthma In Adults Research Articles

Nurses' Role in the Control and Treatment of Asthma in Adults: A Systematic Literature Review.

Bronchial asthma is a chronic pathology and a global public health problem. However, asthma can be controlled and treated for the most part by patients, so the Portuguese General Directorate of Health recommends shared medical appointments in primary health care (PHC). The present study aims to identify the role of PHC nurses in the control and treatment of asthma in adults. Using the MeSH platform, the following descriptors were validated: asthma, nurses, adults. An individual search was carried out in the following databases: CINAHL (ESBSCO host), MEDLINE (Pubmed host), Web of Science, and Scopus. Out of a total of 280 publications, 79 of which were duplicates and 185 publications which did not meet the inclusion criteria, 16 publications remained readable. Of the eligible articles, there were 13 specialist reports, one mixed study, one quasi-experimental study, and one randomized trial. Education was the intervention most identified in the scientific evidence analyzed, and patient assessment, application of an asthma control questionnaire, verification and training of inhalation technique, empowerment for self-management of the disease, support, promotion of seasonal influenza vaccination, and use of written action plans were also identified. The results reveal that, although the scientific evidence on the intervention of these professionals is poorly developed, nurses play a crucial role in the control and treatment of asthma. The scientific evidence analyzed allowed the identification of interventions that can help the organization of a nursing health appointment, providing nurses with a crucial role in the control and treatment of asthma in adults in the context of PHC.

Clinical evidence for acupuncture for adult asthma: Systematic review and meta-analysis of randomised sham/placebo-controlled trials

ObjectiveAcupuncture is a widely used asthma therapy, but the benefits remain uncertain. This study aimed to access the effectiveness of acupuncture for treatment of asthma in adults. MethodsFive English databases and four Chinese databases were searched from inception to November 2021. Randomised sham/placebo-controlled trials meeting inclusion criteria were included. Risk of bias was evaluated according to the Cochrane Review Handbook, and data analysis was performed in RevMan 5.4.1. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) profiler. ResultsSixteen randomised controlled trials (RCTs) were included in the meta-analysis. Results indicated that acupuncture was well-tolerated and could improve FEV1% compared with sham/placebo acupuncture [MD 6.11, 95% CI 0.54–11.68, I2 = 93%, number of participants (n) = 603]. Acupuncture also improved Cai’s Asthma Quality of Life Questionnaire (AQLQ) (MD 7.26, 95% CI 5.02–9.50, I2 = 0, n = 358), and reduced the asthma symptom score (SMD −2.73, 95% CI −3.59 to −1.87, I2 = 65%, n = 120). One study showed acupuncture increased the Asthma Control Test (ACT) score (MD 2.00, 95% CI 0.90–3.10, n = 111), and decreased exacerbation frequency (MD −1.00, 95% CI −1.55 to −1.45, n = 111). Other lung function and medication use parameters were not statistically significant. ConclusionsAcupuncture versus sham/placebo control appeared to improve quality of life, FEV1%, symptoms, and asthma control, and reduced exacerbation frequency per year. Further studies with appropriate controls, more participants, and high-quality evidence are needed.

Efficacy of once-daily, single-inhaler, fixed-dose combination of mometasone/indacaterol/glycopyrronium in patients with asthma with or without persistent airflow limitation: Post hoc analysis from the IRIDIUM study

BackgroundA novel, once-daily, fixed-dose combination of mometasone furoate/indacaterol acetate/glycopyrronium bromide (MF/IND/GLY) delivered via Breezhaler® is the first inhaled corticosteroid/long-acting ꞵ2-agonist/long-acting muscarinic antagonist (ICS/LABA/LAMA) therapy approved for the maintenance treatment of asthma in adults inadequately controlled on ICS/LABA combination. In patients with asthma and persistent airflow limitation (PAL), maximal treatment, especially with combination is suggested. This post hoc analysis of data from the IRIDIUM study assessed the efficacy of MF/IND/GLY in asthma patients with and without PAL. MethodsPatients with post-bronchodilator FEV1 ≤80% of predicted and FEV1/FVC ratio of ≤0.7 were categorised as PAL subgroup and the remaining as the non-PAL subgroup. Lung function parameters (FEV1, PEF, and FEF25%–75%) and annualised asthma exacerbations rates were evaluated in both subgroups across the treatment arms: once-daily high-dose MF/IND/GLY (160/150/50 μg), high-dose MF/IND (320/150 μg) and twice-daily high-dose fluticasone/salmeterol (FLU/SAL; 500/50 μg). ResultsOf the 3092 randomised patients, 64% (n = 1981) met the criteria for PAL. Overall, there was no evidence of treatment difference between PAL and non-PAL subgroups (interaction P-value for FEV1, FEF25%–75%, PEF, moderate or severe exacerbations, severe exacerbations and all exacerbations were 0.42, 0.08, 0.43 0.29, 0.35 and 0.12, respectively). In the PAL subgroup, high-dose MF/IND/GLY versus high-dose MF/IND and high-dose FLU/SAL improved trough FEV1 (mean difference: 102 mL [P < 0.0001] and 137 mL [P < 0.0001]) and reduced moderate or severe (16% and 32%), severe (25% and 39%) and all exacerbations (19% and 38%), respectively. ConclusionsOnce-daily fixed-dose MF/IND/GLY was efficacious in asthma patients with and without persistent airflow limitation.

СУЧАСНІ ПІДХОДИ ЛІКУВАННЯ БРОНХІАЛЬНОЇ АСТМИ ЗГІДНО GINA 2023

In 1993 there was initiated the Global Initiative for Asthma Management and Prevention. Each year GINA is revised and each subsequent revision contains updated recommendations based on new data. It’s underlined in red throughout GINA 2023 the significance of ICScontaining therapy. The best treatment approach for adults and adolescents remains Track 1 with ICS/formoterol as needed. Track 2 now also includes an ICS/SABA combination as needed as an Anti-inflammatory Reliever (AIR), but Track 1 remains the “preferred” regimen. Although inhaled SABA are highly effective for rapid relief of asthma symptoms, patients whose asthma is treated with SABA alone (compared with ICS) have an increased risk of death and asthma-related emergency medical care needs. For safety reasons, GINA does not recommend SABA alone for the treatment of asthma in adults, adolescents, or children 6–11 years of age. Is it possible to treat asthma without SABA? In an asthma center in Argentina, since 2014, a treatment strategy with ICS-containing symptom relievers has been implemented: using only budesonide/formoterol in a single inhaler across all spectrums of asthma severity and completely excluding the use of SABA. As a result, the level of hospitalization decreased by 92%. The 2023 revision of GINA proposed new terminology for anti-asthma drugs: Maintenance therapy, controller drugs, reliever drugs, anti-inflammatory reliever, Maintenance and Reliever Therapy - MART. Clarifications have been made for the treatment of asthma exacerbations. Added details on drugs and doses of ICS/formoterol on demand and ICS/SABA as needed, MART regimen in individual asthma action plan, how and when to modify these drugs as the disease worsens. The inhaler prescription algorithm is written in more details, considering its impact on the environment. Conclusions: The GINA 2023 updates highlight the most significant role of ICS-containing therapy in achieving asthma control and preventing exacerbations. However, patient adherence to therapy remains quite low, so an approach that allows for the management of both symptoms and exacerbations simultaneously is simpler and remains the preferred way of asthma therapy. Global approaches to asthma management - limiting, where possible, the use of SABA and favoring delivery devices and treatment regimens with less environmental impact. Managing the patient according to his personal action plan and creating local protocols can limit the use of SABA, improve the patient’s asthma outcomes and environmental impact. Key words: asthma, GINA, inhalers, asthma control, exacerbation

Involvement of esterases in the pulmonary metabolism of beclomethasone dipropionate and the potential influence of cannabis use

Beclomethasone dipropionate (BDP) is an inhaled glucocorticoid used for maintenance treatment of asthma in adults and children. BDP is a prodrug activated in lung when hydrolyzed to its major active metabolite beclomethasone-17-monopropionate (17-BMP), which can be further deactivated to beclomethasone (BOH). The specific hydrolases contributing to these processes have not been identified which warrants an investigation to enable a better assessment of the drug-drug interaction (DDI) liability and a better management of drug efficacy and systemic toxicity. In the present study, the pulmonary metabolism of BDP was investigated using both human lung S9 (HLuS9) and recombinant carboxylesterase 1 (CES1) S9. By employing the relative activity approach, we tested the hypothesis of CES1 being the major enzyme involved. Assessment of other hydrolases were conducted in an assay with selective esterase inhibitors. In addition, the DDI potentials between BDP and Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) were evaluated due to the increasing use of inhaled cannabis both recreationally and medically. The mechanism of DDI was conducted in an in vitro time-dependent inhibition assay, and further interpreted utilizing a proposed model. In HLuS9, BDP was efficiently metabolized almost completely to 17-BMP, which was then converted to BOH at a much lower rate. CES1 was found as a minor contributor accounting for only 1.4% of BDP metabolism in HLuS9, while arylacetamide deacetylase might be the main enzyme involved. Both THC and CBD inhibited the HLuS9 mediated BDP hydrolysis in a reversible manner, with reported IC50 values estimated as 8.98 and 36.8 μM, respectively. Our proposed model suggested a moderately decreased 17-BMP exposure in lung by concomitant THC from a cannabis cigarette, while the effects from orally administered CBD was expected to be of no clinical relevance.

The Effect of Compound Honey Syrup on Clinical Manifestation of the Adult Asthma Patients: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Asthma is a chronic inflammatory disease of the respiratory tract which includes inflammation and obstruction of the airways. Modern medical treatment has side effects in addition to therapeutic effects. According to the high incidence of asthma, the use of complementary therapies has risen, such as compound honey syrup in Traditional Persian medicine and Integrative medicine as a treatment for asthma. Therefore, the aim of this study was to evaluate the effect of compound honey syrup in improving the clinical symptoms of adult asthma referred to Loghman hospital. This randomized, double-blinded, controlled trial was performed on 80 patients with asthma symptoms. Patients were divided into two groups of 40 and the study was conducted for 12 weeks. The intervention group received classic asthma treatment and compound honey syrup. The control group also received classic asthma treatments plus placebo. The questionnaire was done by individuals at the beginning and end of the study. At the end of study some factors like night symptoms, morning symptoms, activity limitation, shortness of breath, wheezing, and use of Short Acting Beta Agonist (SABA) were significantly decreased in both groups, but it had a greater extent in the intervention group than in the control group. Difference in total scores and some items of Asthma Control Test (ACT) were significant between groups (P &lt; 0.05). No serious adverse effects were observed in any of the groups. The results of this study demonstrate that compound honey syrup can be a safe and effective drug for the treatment of asthma in adults.

A Review of the Unique Drug Development Strategy of Indacaterol Acetate/Glycopyrronium Bromide/Mometasone Furoate: A First-in-Class, Once-Daily, Single-Inhaler, Fixed-Dose Combination Treatment for Asthma.

A novel, once-daily (o.d.), fixed-dose combination (FDC) of indacaterol acetate (IND), glycopyrronium bromide (GLY), and mometasone furoate (MF), delivered by the inhaler Breezhaler® device, is the first long-acting beta2-adrenergic agonist/long-acting muscarinic antagonist/inhaled corticosteroid (LABA/LAMA/ICS) therapy to be approved for maintenance treatment of asthma in adults inadequately controlled on LABA/ICS. The approval of IND/GLY/MF in the European Union (EU) also included an optional electronic sensor and smartphone (or other suitable device) application, making it the first “digital companion” that can be prescribed with an asthma medication. As a result, the European Medicines Agency included this approval as one of the “outstanding contributions to public health” (for Pneumology/Allergology) in their 2020 highlights report. Alongside IND/GLY/MF, an o.d. LABA/ICS FDC, IND/MF, was also developed and approved. This review outlines the unique strategy used in the accelerated development of IND/GLY/MF that combined various approaches: (1) selecting individual components with established efficacy/safety, (2) bridging doses to optimize efficacy/safety of IND/GLY/MF and IND/MF delivered via the Breezhaler® device, (3) developing IND/GLY/MF and IND/MF in parallel, and (4) submission for regulatory approval before formal completion of the pivotal phase III studies. IND/GLY/MF and IND/MF were combined in a single-development plan (PLATINUM program), which comprised four phase III studies: QUARTZ and PALLADIUM evaluated IND/MF while IRIDIUM and ARGON evaluated IND/GLY/MF. A unique feature was the inclusion of two LABA/ICS comparators in the pivotal IRIDIUM study—IND/MF as an internal comparator, and high-dose salmeterol xinafoate/fluticasone propionate (SAL/FLU) as a marketed comparator. In the ARGON study, IND/GLY/MF was compared against o.d. tiotropium (via Respimat®) plus twice-daily (b.i.d.) high-dose SAL/FLU (via Diskus®). As a result of this development strategy, the development and approval of IND/GLY/MF was accelerated by ca. 4 years as against what would be expected from a traditional approach, novel data were generated, and a unique optional digital companion was approved in the EU. A Video by Dr Dominic Brittain, Global Drug Development, Novartis. (MP4 228293 kb)Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-02025-w.

‘Real-world’ effectiveness of omalizumab in adults with severe allergic asthma: a meta-analysis

ABSTRACT Background: Severe asthma affects 5–10% of the 350 million people with asthma worldwide. Findings from the authors’ previous meta-analysis supported omalizumab use as an adjuvant treatment for severe allergic asthma. The publication of fourteen new articles necessitates an update of the meta-analysis. Objective: To evaluate the ‘real-world’ effectiveness of omalizumab in the treatment of acute allergic asthma in adults by calculating pooled effects estimates from data in published articles. Methods: Articles on omalizumab effectiveness in ‘real-world’ settings were identified. Effect sizes, including point estimates of the proportion of patients who met a given criteria, mean improvements relative to baseline, and change in the proportion of patients requiring oral corticosteroids compared to baseline were extracted. Meta-analysis of proportions was conducted to pool effect sizes based on proportions. Standardized mean differences (Hedges’ g) were calculated from means and standard deviations. Relative risk was calculated from changes in proportions. Variability within and between studies was evaluated. Results: Omalizumab increases the percentage of individuals rated ‘good’ or ‘excellent’ on the Global Evaluation of Treatment Effectiveness Scale. Omalizumab also improves respiratory function, quality-of-life, and asthma control while reducing medication usage, exacerbations, hospitalizations, and adverse events. Conclusion: ‘Real-world’ evidence continues to support the use of omalizumab as adjuvant treatment for severe allergic asthma.

The Treatment of Mild and Moderate Asthma in Adults.

Asthma is a chronic inflammatory airway disease that usually causes variable airway obstruction. It affects 5-10% of the German population. This review is based on relevant publications retrieved by a selective search, as well as on national and international guidelines on the treatment of mild and moderate asthma in adults. The goal of treatment is to attain optimal asthma control with a minimal risk of exacerbations and mortality, loss of pulmonary function, and drug side effects. This can be achieved with a combination of pharmacotherapy and non-drug treatment including patient education, exercise, smoking cessation, and rehabilitation. Pharmacohterapy is based on inhaled corticosteroids (ICS) and bronchodilators. It is recommended that mild asthma should be treated only when needed, either with a fixed combination of ICS and formoterol or with short-acting bronchodilators. For moderate asthma, maintenance treatment is recommended, with an inhaled fixed combinations of ICS and long-acting beta-mimetics, possibly supplemented with longacting anticholinergic agents. Allergen immunotherapy, i.e., desensitization treatment, should be considered if the allergic component of asthma is well documented and the patient is not suffering from uncontrolled asthma. Asthma control should be monitored at regular intervals, and the treatment should be adapted accordingly. The treatment of asthma in adults should be individually tailored, with anti-inflammatory treatment as its main component.

Latest Information on the Diagnosis and Treatment of Adult Asthma

Latest Information on the Diagnosis and Treatment of Adult Asthma

Fluticasone-Vilanterol as Needed for the Treatment of Mild Asthma in Adults

Fluticasone-Vilanterol as Needed for the Treatment of Mild Asthma in Adults

Are long-acting beta-agonists effective in the treatment of adult asthma?

Are long-acting beta-agonists effective in the treatment of adult asthma?

Future perspectives of anticholinergics for the treatment of asthma in adults and children.

Despite major advances in therapeutic interventions and the availability of detailed treatment guidelines, a high proportion of patients with symptomatic asthma remain uncontrolled. Asthma management is largely guided by the Global Initiative for Asthma (GINA) strategy and is based on a backbone of inhaled corticosteroid (ICS) therapy with the use of additional therapies to achieve disease control. Inhaled long-acting bronchodilators alone and in combination are the preferred add-on treatment options. Although long-acting muscarinic antagonists (LAMAs) are a relatively recent addition to disease management recommendations for asthma, tiotropium has been extensively studied in a large clinical trial program. In Europe and the United States, tiotropium is approved for patients aged ≥6 years and uncontrolled on medium- to high-dose ICS/long-acting β2-agonists at GINA Steps 4 and 5 with a history of exacerbations. Evidence supports the efficacy of tiotropium Respimat® in adults in terms of lung function and asthma control, with a safety profile comparable with that of placebo across a range of asthma severities. Similarly, clinical trials in patients aged 1–17 years have shown improvements in lung function and trends toward improved asthma control. Furthermore, its efficacy makes tiotropium relatively easy to incorporate into routine clinical practice, irrespective of allergic status and without the need for patient phenotyping. Tiotropium is a cost-effective treatment that may offer an important alternative to other, more expensive add-on therapies. This review discusses the potential future position of LAMAs in clinical practice by considering the continuously evolving evidence. Prominence is given to tiotropium, the only LAMA supported by a structured clinical trial program in asthma to date, while also considering other recommended treatment options for patients with uncontrolled asthma. The importance of effective patient/caregiver–clinician communication and shared decision-making in enhancing treatment adherence is also highlighted.

Assessing asthma in the otolaryngologist's office.

To familiarize otolaryngologists and other practitioners with basic diagnosis and treatment of asthma in adults and children based on current literature. Increased fractional excretion of nitrous oxide and sputum eosinophils have been identified in asthmatic patients being evaluated for chronic cough and appear to be more sensitive in diagnosis than traditional spirometry. Both sublingual and subcutaneous immunotherapy modalities are effective in decreasing symptoms and medication use in patients with allergic rhinitis and allergic asthma. Undiagnosed comorbid asthma is prevalent among patients with chronic rhinosinusitis and allergic rhinitis and control of all diseases processes greatly improves quality of life. Office spirometry is a helpful tool in the evaluation and management of asthma. Otolaryngologists should be able to recognize undiagnosed or poorly controlled asthma, initiate and improve medical therapy, and treat rhinosinusitis to improve asthma control.

Fluticasone furoate/vilanterol dry-powder inhaler in asthma: a guide to its use in the EU

Fluticasone furoate/vilanterol [Relvar®, Revinty® (EU); Breo® (USA)], a fixed-dose combination of an inhaled corticosteroid (ICS) and a long-acting β2-adrenoreceptor agonist (LABA), is delivered via Ellipta®, a dry powder inhaler and is administered once daily. EU approval of the combination for the treatment of asthma in adults and adolescents, for whom ICS/LABA therapy is appropriate, was based on the findings of phase 3 trials in patients (aged ≥12 years) whose asthma was uncontrolled by ICS and/or ICS/LABA therapy. Once-daily fluticasone furoate/vilanterol improved pulmonary function in these studies, being as effective as twice-daily fluticasone propionate/salmeterol and more effective than twice-daily fluticasone propionate. In addition, fluticasone furoate/vilanterol reduced the risk of severe asthma exacerbations, and improved asthma control and measures of asthma-related quality of life. It is generally well tolerated and, due to the low systemic exposure to fluticasone furoate and vilanterol when administered via inhalation, does not appear to be associated with clinically relevant systemic effects. With the added convenience of once-daily administration (which has the potential to improve treatment adherence in some patients), fluticasone furoate/vilanterol is a useful addition to the other fixed ICS/LABA combinations currently available for asthma, all of which require twice-daily administration.

Tiotropium in the add-on treatment of asthma in adults: clinical trial evidence and experience

Asthma is a chronic inflammatory airway disease, and its treatment is frequently challenging despite detailed national and international guidelines. While basic anti-inflammatory therapy usually consists of inhaled corticosteroids in doses adapted to the asthma severity, add-on treatment with bronchodilators is essential in more severe asthma. Only recently, the long-acting anticholinergic tiotropium was introduced into the GINA guidelines. This review reports on the studies that have been performed with tiotropium in adult asthmatic patients. Following early proof-of-concept studies, several studies with tiotropium as an add-on therapy to inhaled corticosteroids (ICS), with or without a long-acting beta agonist (LABA), demonstrated convincing clinical benefit for patients. Important lung function parameters and quality of life scores significantly improved shortly after onset of the add-on therapy with tiotropium, and some studies even demonstrated non-inferiority against salmeterol. All studies reported an excellent safety profile of tiotropium. The still growing body of tiotropium studies, both in adults and children, will help to identify the position of tiotropium in future asthma guidelines and might also indicate which patients benefit most from an add-on therapy with tiotropium.

Health Service Utilization and Poor Health Reporting in Asthma Patients.

The management and treatment of adult asthma has been associated with utilization of health services. Objectives: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data Source: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). Study Design: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Findings: Those with asthma are found more likely (OR 1.50, 95% CI 1.05–2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56–11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32–2.65) and hospitalization (OR 2.21, 95% CI 1.39–3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Conclusion: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are increasingly more likely to be characterized as frequent utilizers of both primary and emergency department care as the threshold for what constitutes frequent utilization increases. Investments in prevention and better management of the chronic condition may result in less demand for acute care services, especially among high frequency utilizers.

Acupoint Application for Asthma Therapy in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: To evaluate the evidence available on the effects of acupuncture point (acupoint) application for asthma therapy in adults. Methods: Six electronic databases were searched up to May 2014 to identify relevant studies. Randomized controlled trials, which assessed the effects of acupoint application for asthma treatment in adults, were included in our review. The methodological quality of eligible studies was assessed by the Cochrane Collaboration's tool. The standardized mean difference (SMD) and 95% confidence intervals (CI) of a random-effects model were calculated. The heterogeneity was assessed using I²statistics. Results: Eight studies were included in our review. The aggregated results indicated that acupoint application improved forced expiratory volume in 1 second (FEV1) (SMD, 0.32; 95% CI 0.04-0.60; p = 0.03), FEV1/forced vital capacity (SMD, 0.89; 95% CI 0.70-1.09; p < 0.00001), interleukin (SMD, -0.26; 95% CI -0.50 to -0.01; p = 0.04) and immunoglobulin E (SMD, -0.49; 95% CI -0.83 to -0.16; p = 0.004) in patients with asthma, but not eosinophilic cation protein (SMD, -0.58; 95% CI -1.42 to 0.26; p = 0.18). There was no sufficient evidence for the follow-up effects of acupoint application for asthma therapy in adults. Conclusions: Acupoint application may be a valid complementary and alternative therapy for asthma in adults. It contributes especially to improving pulmonary function and reducing the levels of interleukin and immunoglobulin E. However, more studies with longer follow-ups are warranted to confirm the current findings.

Budesonide/salmeterol in fixed-dose combination for the treatment of asthma

Fixed dose combinations (FDC) of inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) are well established in asthma treatment. The budesonide/salmeterol (B/S) FDC is now about to reach the market. It is provided as powder in hard capsules of two strengths: 120/20μg and 240/20μg when expressed as delivered doses, equivalent to 150/25μg and 300/25μg when expressed as nominal doses. Its development involved 9 pharmacokinetic (320 subjects), 3 phase II (123 subjects) and 4 phase III (1206 patients with different asthma severity) studies. Delivery is effectuated via low resistance inhaler device, Axahaler®, generating also fine particles targeting the small airways. B/S safety, assessed in 1401 subjects, did not outline novel concerns specific for this FDC. In conclusion, the B/S dry powder FDC can be used for asthma treatment in adults not adequately controlled on ICS alone, or to maintain control of ICS/LABA treated patients, in whom switching to alternative FDC is indicated.

Biomarkers of adult asthma and personalized medicine

The concept of personalized medicine for disease diagnosis, treatment, and management, considering individual variability, including susceptibility, clinical manifestations, and drug responsiveness, is a global emerging trend in medicine, which is also inevitable. However, clinical applications of personalized medicine in the real-world practice have been limited to certain cancers so far. Furthermore, this new concept to the diagnosis and treatment of adult asthma has not been applied to clinical use. Asthma is a multifactorial and heterogeneous disease. It seems to encompass a broad spectrum of clinical manifestations with different underlying pathophysiological mechanisms. Thus, it is not easy to categorize by their clinical features alone. Endotypical categorization that considering specific pathophysiological mechanisms will be more helpful in applying the concept of personalized medicine. The success of personalized medicine depends on patient selection for precise prescription of asthma medications. In the recent years, many investigators and physicians have devoted a lot of effort to the discovery of reliable biomarkers in asthmatic patients, which will be able to actualize the personalized medicine in near future. Despite such great efforts toward investigation of good biomarkers, few things have turned out to be practical in the clinic. Easily interpretable biomarkers of asthma are necessary to assess early detection, determination of treatment, prognosis prediction, and monitoring of exacerbation. Herein, we review recent studies regarding disease classifications and biomarkers of asthma. (Allergy Asthma Respir Dis 2016;4:4-13)