Asthma Control Affected by Inhaled Corticosteroids Particle Size

The use of extrafine inhaled corticosteroids (ICSs) is associated with a higher likelihood of achieving asthma control at lower prescribed doses vs fine-particle ICSs in patients with asthma, according to a recent systematic review and meta-analysis.

Previous evidence has indicated that the particle size of ICSs may impact the deposition and effectiveness of airway drugs.
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For their analysis, the researchers assessed 33,453 individuals ages 5 to 80 years enrolled in 7 different studies between January 2004 and June 2016. Patient data was obtained via MEDLINE and EMBASE databases.

All studies included in the analysis had reported odds and relative risk ratios, had met the quality standards of the Respiratory Effectiveness Group/European Academy of Allergy and Clinical Immunology, compared extrafine ICSs with the same or different types of ICS molecules, and followed patients for 12 months or longer. Six of the 7 included studies compared fine-particle ICSs with extrafine beclometasone propionate, while 1 study compared fine-particle ICSs with both extrafine beclometasone propionate and extrafine ciclesonide.

The researchers pooled end-point data regarding asthma control, exacerbations, prescribed doses of ICSs, and used random-effects meta-analysis modeling.

Results indicated that patients on extrafine ICSs were significantly more likely to achieve asthma control vs those on fine-particle ICSs. The researchers observed that the use of extrafine ICSs was associated with lower overall exacerbation rate ratios and lower dosage levels, compared with the use of fine-particle ICS.

“This meta-analysis demonstrates that extrafine ICSs have significantly higher odds of achieving asthma control with lower exacerbation rates at significantly lower prescribed doses than fine-particle ICSs,” the researchers concluded.

—Christina Vogt

Reference:

Sonnappa S, McQueen B, Postma DS, et al. Extrafine versus fine inhaled corticosteroids in relation to asthma control: a systematic review and meta-analysis of observational real-life studies [Published online September 20, 2017]. J Allergy Clin Immunol: In Pract. http://dx.doi.org/10.1016/j.jaip.2017.07.032.