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Study Examines Effect of Switching from Multi-Inhaler to Single-Inhaler for Patients with Severe COPD

By Adam Hochron
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For patients with severe COPD, finding the right treatment option to best manage symptoms can be an involved process. A recent clinical trial looked at whether switching from non-extra fine to extra fine therapeutic particles can improve bronchodilation and ventilation for these patients. 

The multi-center, open-label trial included patients with asymptomatic severe COPD who had previously been treated with a stable dose non-extra fine multi-inhaler triple therapy with inhaled corticosteroid/long-acting b2 agonist and a long-acting muscarinic antagonist for more than three months. The patients were switched to a single-inhaler extra-fine mist therapy with beclomethasone dipropionate/formoterol fumarate/glycopyrronium bromide pressurized metered dose inhaler for two weeks. Results of the trial were presented at the virtual CHEST annual meeting. 

Researchers enrolled 21 patients, with all but one finishing the study. The mean age was 63.4 years, with an FEV1 of 40.5% of the predicted normal. A release about the trial noted that 55% of the patients were smokers, with 70% showing predominant emphysema on a CT scan. At week 24 of the trial, the overall percent change from baseline was +22.0% (p<0.001) for specific inner airway volume (siVaw) and -17.6% (p=0.014) for specific inner airway resistance (siRaw) at total lung capacity.

The change from baseline in SGRQ total score was “inversely correlated to siVaw (r=0.470, p=0.042) whereas change from baseline in FEV1 bore no correlation to either siVaw (r=0.299), p=0.214) or siRaw (r=0.349, p=0.143),” the release noted. Switching from a non-extra fine MITT to extra fine BDP/FF/GB was found to increase peripheral lung disposition of ICS 19.8 plus or minus 3.8%, LABA by 18.8 plus or minus 3.4%, and LAMA by 13.2 plus or minus 7.1% of delivered dose respectively. 

“FRI signatures but not FEV1 capture the significant bronchodilation effect occurring after 24 weeks following switch from non-extra fine to extra fine inhaled triple therapy in patients with severe COPD,” the release noted. “Switching to extra fine BDP/FF/GB pMDI results in enhanced regional ventilation to the small airways as assessed by CT surrogate ventilation maps.”