Comparative efficacy of leukotriene modifier and inhaled corticosteroids in the complex treatment of steroid-naive patients with bronchial asthma combined with chronic obstructive pulmonary disease with neutrophilic type of inflammation
DOI:
https://doi.org/10.14739/2310-1210.2021.4.229508Keywords:
bronchial asthma, chronic obstructive lung disease, treatmentAbstract
The aim: to compare the efficacy and tolerability of the leukotriene modifier and inhaled corticosteroids in combination with long-acting β2-agonist formoterol in steroid-naive patients with asthma combined with COPD with neutrophilic inflammation.
Materials and methods. After obtaining the written consent, 30 patients with asthma combined with COPD and a number of blood neutrophils >4000/μl were randomized (1:1): group I – received a fixed combination of budesonide/formoterol 160/4.5 μg/1 inhalation twice daily as a basic therapy; group II – montelukast 1 tab. (10 mg) once daily and inhalation of formoterol 12 mcg/dose twice daily. The duration of therapy was 12 weeks. General clinical methods, asthma control questionnaires, COPD questionnaire, physical tolerance evaluation (6-minute walk test), pulmonary function tests, quality of life assessment were performed to all the patients before and after the treatment course studied.
Results. The combination of budesonide/formoterol improved clinical symptoms – significantly (P < 0.05) increased the total ACT score, decreased the average ACQ score, shortness of breath (mMRC scale), COPD symptoms. PFT indices were improved significantly (P < 0.05), bronchoobstruction at the level of large, medium and small bronchi was significantly reduced. Physical tolerance was significantly improved. There were no statistically significant dynamics of the studied indices in patient group II. The patients of both groups showed a tendency to improve their quality of life. In patients of I group, there was a significant decrease in activity limitations and the total SGRQ score.
Conclusions. The combination of inhaled corticosteroid/formoterol has proven to be more effective than the leukotriene modifier or formoterol in steroid-naive patients with asthma combined with COPD and neutrophilic inflammation.
References
Hosseini, M., Almasi-Hashiani, A., Sepidarkish, M., & Maroufizadeh, S. (2019). Global prevalence of asthma-COPD overlap (ACO) in the general population: a systematic review and meta-analysis. Respiratory Research, 20(1), Article 229. https://doi.org/10.1186/s12931-019-1198-4
Yanagisawa, S., & Ichinose, M. (2018). Definition and diagnosis of asthma-COPD overlap (ACO). Allergology International, 67(2), 172-178. https://doi.org/10.1016/j.alit.2018.01.002
Halpin, D. (2020). What Is Asthma Chronic Obstructive Pulmonary Disease Overlap? Clinics in Chest Medicine, 41(3), 395-403. https://doi.org/10.1016/j.ccm.2020.06.006
Tochino, Y., Asai, K., Shuto, T., & Hirata, K. (2017). Asthma-COPD overlap syndrome-Coexistence of chronic obstructive pulmonary disease and asthma in elderly patients and parameters for their differentiation. Journal of General and Family Medicine, 18(1), 5-11. https://doi.org/10.1002/jgf2.2
Gibson, P. G., & Foster, P. S. (2019). Neutrophilic asthma: welcome back! The European Respiratory Journal, 54(5), Article 1901846. https://doi.org/10.1183/13993003.01846-2019
Yang, X., Li, H., Ma, Q., Zhang, Q., & Wang, C. (2018). Neutrophilic Asthma Is Associated with Increased Airway Bacterial Burden and Disordered Community Composition. BioMed Research International, 2018, Article 9230234. https://doi.org/10.1155/2018/9230234
Ray, A., & Kolls, J. K. (2017). Neutrophilic Inflammation in Asthma and Association with Disease Severity. Trends in Immunology, 38(12), 942-954. https://doi.org/10.1016/j.it.2017.07.003
Thomson, N. C. (2016). Novel approaches to the management of noneosinophilic asthma. Therapeutic Advances in Respiratory Disease, 10(3), 211-234. https://doi.org/10.1177/1753465816632638
Global Initiative for Asthma. (2020). Global Strategy for Asthma Management and Prevention (Updated 2020). https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf
Feshchenko, Yu. I., Yashyna, L. O., Havrysiuk, V. K., Krakhmalova, O. O., Matiukha, L. F., Mostovyi, Yu. M., Pertseva, T. O., Polianska, M. O., Rekalova, O. M., Ostrovskyi, M. M., Zaikov, S. V., Konopkina, L. I., & Konstantynovych, T. V. (2020). Adaptovana klinichna nastanova, zasnovana na dokazakh. Bronkhialna astma [Adapted evidence-based clinical guideline. Bronchial asthma]. Natsionalna akademiia medychnykh nauk Ukrainy. [in Ukrainian].
Ministry of Health of Ukraine. (2013, October 08). Pro zatverdzhennia ta vprovadzhennia medyko-tekhnolohichnykh dokumentiv zi standartyzatsii medychnoi dopomohy pry bronkhialnii astmi [On Approval and implementation of the technological medical documents on standardizing the management of bronchial asthma (No. 868)]. https://zakon.rada.gov.ua/rada/show/v0868282-13#Text
Ministry of Health of Ukraine. (2013, June 27). Pro zatverdzhennia ta vprovadzhennia medyko-tekhnolohichnykh dokumentiv zi standartyzatsii medychnoi dopomohy pry khronichnomu obstruktyvnomu zakhvoriuvanni lehen [On Approval and implementation of the technological medical documents on standardizing the management of chronic obstructive pulmonary disease (No. 555)]. https://zakon.rada.gov.ua/rada/show/v0555282-13#Text
Esteban-Gorgojo, I., Antolín-Amérigo, D., Domínguez-Ortega, J., & Quirce, S. (2018). Non-eosinophilic asthma: current perspectives. Journal of Asthma and Allergy, 11, 267-281. https://doi.org/10.2147/JAA.S153097
Maselli, D. J., & Hanania, N. A. (2019). Management of asthma COPD overlap. Annals of Allergy, Asthma, & Immunology, 123(4), 335-344. https://doi.org/10.1016/j.anai.2019.07.021
Bonini, M., & Usmani, O. S. (2015). The role of the small airways in the pathophysiology of asthma and chronic obstructive pulmonary disease. Therapeutic Advances in Respiratory Disease, 9(6), 281-293. https://doi.org/10.1177/1753465815588064
Feshchenko, Y. I., Iashyna, L. O., Ignatieva, V. I., Polianska, M. O., Nazarenko, K. V., Gumeniuk, G. L., Moskalenko, S. M., Opimakh, S. G., & Zvol, I. V. (2019). Osoblyvosti bronkhialnoi astmy z neitrofilnym typom zapalennia [Features of bronchial asthma with neutrophilic inflammation]. Astma ta alerhiia, (3), 35-40. https://doi.org/10.31655/2307-3373-2019-3-35-40 [in Ukrainian].
Global Initiative for Chronic Obstructive Lung Disease. (2021). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. (2021 report). https://goldcopd.org/2021-gold-reports/
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