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Extrafine inhaled corticosteroid therapy in the control of asthma

Authors Ivancsó I, Böcskei R, Müller V, Tamási L

Received 7 December 2012

Accepted for publication 30 April 2013

Published 6 June 2013 Volume 2013:6 Pages 69—80

DOI https://doi.org/10.2147/JAA.S25415

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4


István Ivancsó, Renáta Böcskei, Veronika Müller, Lilla Tamási

Department of Pulmonology, Semmelweis University, Budapest, Hungary

Abstract: Small airways disease plays an important role in the pathogenesis of asthma, but assessment of small airways impairment is not easy in everyday clinical practice. The small airways can be examined by several invasive and noninvasive methods, most of which can at present be used only in the experimental setting. Inhalers providing extrafine inhaled corticosteroid particle sizes may achieve sufficient deposition in the peripheral airways. Many studies have reported the beneficial effects of extrafine inhaled corticosteroids on inflammation, ie, on dysfunction in both the central and distal airways in asthmatics, and there are some data on asthma phenotypes in which the small airways seem to be affected more than in other phenotypes, including nocturnal asthma, severe steroid-dependent or difficult-to-treat asthma, asthma complicated by smoking, elderly asthmatic patients and/or patients with fixed airflow obstruction, and asthmatic children. The relevant randomized controlled clinical trials indicate that the efficacy of extrafine and nonextrafine inhaled corticosteroid formulations is similar in terms of primary endpoints, but there are certain clinically important endpoints for which the extrafine formulations show additional benefits.

Keywords: small airways, inflammation, dysfunction, noninvasive evaluation methods, peripheral deposition

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