The use of a pressurized metered-dose inhaler (pMDI) was found to have comparable efficacy and safety with that of a dry powder inhaler (DPI) in older patients with moderate to severe asthma, according to a study published in Allergy, Asthma & Immunology Research.1
In this 12-week, randomized, open-label, parallel-design study conducted at the Ajou University Hospital in Suwon, Korea, 63 patients (ages, >55 years) with moderate to severe asthma for >6 months were randomly assigned to be treated with a p-MDI (n=30) or a DPI (n=33). Asthma diagnosis was based on clinical symptoms (ie, dyspnea, chest tightness, cough, and wheezing), airway reversibility (ie, an increase in forced expiratory volume in 1 second [FEV1] ≥12% and 200 mL from prebronchodilator use), and airway hyperresponsiveness (ie, provocative concentration of methacholine resulting in a 20% decline in FEV1 <16 mg/mL of methacholine).
The use of a combination of inhaled corticosteroids and long-acting β2 agonists for the treatment of patients with moderate to severe asthma is recommended in the Global Initiative for Asthma guidelines.2 In this study, asthma control was evaluated based on these guidelines. The study’s primary endpoint was the percentage of participants achieving well-controlled asthma after the 12-week study period. Secondary study endpoints included changes in lung function parameters, fractional exhaled nitric oxide (FeNO) levels, asthma control test (AST) scores, percentage of patients with asthma exacerbation, inhalation technique, and adherence to therapy.
No significant differences were observed in the rates of well-controlled asthma between the p-MDI and DPI groups at week 4 (40.0% vs 33.3%, respectively) and week 8 (56.7% vs 36.4%, respectively). The rate of well-controlled asthma in the p-MDI group was noninferior to that in the DPI group at 12 weeks (53.3% vs 45.5%, respectively, P <.001, using a predefined noninferiority limit of 17%). The percentage of patients who did not attain well-controlled asthma in the p-MDI group was noninferior to that in the DPI group for participants with a long disease duration (ie, ≥15 years; difference, 12.7%) and for participants with higher degrees of air trapping (ie, residual volume/total lung capacity ≥45%; difference, 17.5%; P <.001 for both). No significant differences were reported between the 2 groups in terms of lung function parameters, inhalation techniques, treatment adherence, and adverse reactions.
“p-MDI can be an effective treatment option for older patients with uncontrolled asthma, particularly in those with longer disease duration and higher air trapping,” concluded the study authors.
1. Woo S-D, Ye Y-M, Lee Y, et al. Efficacy and safety of a pressurized metered-dose inhaler in older asthmatics: comparison to a dry powder inhaler in a 12-week randomized trial. Allergy Asthma Immunol Res. 2020;12(3):454-466. doi: 10.4168/aair.2020.12.3.454
2. Global Initiative for Asthma. Global strategy for asthma management and prevention 2015. Global Initiative for Asthma; 2015. http://www.ginasthma.org. Accessed April 9, 2020.