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Assessing inhaled corticosteroid adherence and responsiveness in severe asthma using beclometasone dipropionate/formoterol NEXThaler™ dose-counting and nitric oxide monitoring

journal contribution
posted on 2024-04-12, 11:44 authored by Hnin WW Aung, Claire E Boddy, Eleanor Hampson, Mark Bell, Lauren A Parnell, Kumaran Balasundaram, Anna C Murphy, Shamsa Naveed, Peter Bradding

Background

65% of people with severe asthma and a FeNO ≥45 ppb are non-adherent to inhaled corticosteroids (ICS). Digital devices recording both time-of-use and inhaler technique identify non-adherence and ICS responsiveness but are not widely available. As the NEXThaler™ dose counter only activates at an inspiratory flow of 35 L/min, this may provide an alternative to identifying ICS responsiveness.

Objective

To assess ICS adherence and responsiveness in severe asthma using beclometasone/formoterol (200/6 mcg) NEXThaler™ (BFN) dose-counting.

Methods

Severe asthmatics with a FeNO ≥45 ppb were invited to use BFN in place of their usual ICS/long-acting β2-agonist (LABA). FeNO, ACQ6, lung function and blood eosinophil count were monitored for 3 months. A log10ΔFeNO ≥0.24 was used to define FeNO suppression as the primary marker of ICS responsiveness at day 28.

Results

27/48 (56%) patients demonstrated significant FeNO suppression at month 1 (median pre-114, post-48 ppb, p<0.001). A small but significant reduction occurred in FeNO non-suppressors. ACQ6 fell a median 1.2 units in FeNO suppressors (p<0.001) and 0.5 units in non-suppressors (p=0.025). These effects were sustained until month 3 in FeNO suppressors with a significant improvement in FEV1 and blood eosinophils. 67% (18/27) of those with baseline ICS/LABA prescription refills of ≥80% were FeNO suppressors suggesting prior non-adherence despite adequate prescription collection. 79% of FeNO suppressors did not require biologics within mean 11.4 months from initial dose counting.

Conclusion

BFN dose counting identifies ICS responsiveness in severe asthma with the implication that these patients may not need to progress to biological therapies.

History

Author affiliation

College of Life Sciences/Respiratory Sciences

Version

  • AM (Accepted Manuscript)

Published in

The Journal of Allergy and Clinical Immunology: In Practice

Pagination

S2213-2198(24)00288-5

Publisher

Elsevier BV

issn

2213-2198

eissn

2213-2201

Copyright date

2024

Available date

2025-03-20

Spatial coverage

United States

Language

en

Deposited by

Professor Peter Bradding

Deposit date

2024-04-11

Rights Retention Statement

  • No

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