title: Novel functional imaging of changes in small airways of patients treated with extrafine beclomethasone/formoterol.
abstract: BACKGROUND
  Inhaled formulations using extrafine particles of long-acting β2-agonists and corticosteroids were developed to optimize asthma treatment. Findings that these combinations reach and treat smaller airways more effectively are predominantly based on general non-specific outcomes with little information on regional characteristics.
  
  
  OBJECTIVE
  This study aims to assess long-term effects of extrafine beclomethasone/formoterol on small airways of asthmatic patients using novel functional imaging methods.
  
  
  METHODS
  Twenty-four stable asthma patients were subdivided into three groups (steroid naive, n = 7; partially controlled, n = 6; well controlled, n = 11). Current treatment was switched to a fixed combination of extrafine beclomethasone/formoterol (Foster®; Chiesi Pharmaceuticals, Parma, Italy). Patients underwent lung function evaluation and thorax high-resolution computerized tomography (HRCT) scan. Local airway resistance was obtained from computational fluid dynamics (CFD).
  
  
  RESULTS
  After 6 months, the entire population showed improvement in pre-bronchodilation imaging parameters, including small airway volume (p = 0.0007), resistance (p = 0.011), and asthma control score (p = 0.016). Changes in small airway volume correlated with changes in asthma control score (p = 0.004). Forced expiratory volume in 1 s (p = 0.044) and exhaled nitric oxide (p = 0.040) also improved. Functional imaging provided more detail and clinical relevance compared to lung function tests, especially in the well-controlled group where only functional imaging parameters showed significant improvement, while the correlation with asthma control score remained.
  
  
  CONCLUSIONS
  Extrafine beclomethasone/formoterol results in a significant reduction of small airway obstruction, detectable by functional imaging (HRCT/CFD). Changes in imaging parameters correlated significantly with clinically relevant improvements. This indicates that functional imaging is a useful tool for sensitive assessment of changes in the respiratory system after asthma treatment.
authors.affiliation: FluidDA nv, Kontich, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Vos
authors.forename: Jan
authors.initials: J
authors.lastname: De Backer
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Poli
authors.forename: Annick
authors.initials: A
authors.lastname: De Volder
authors.forename: Liesbet
authors.initials: L
authors.lastname: Ghys
authors.forename: Cedric
authors.initials: C
authors.lastname: Van Holsbeke
authors.forename: Samir
authors.initials: S
authors.lastname: Vinchurkar
authors.forename: Lieve
authors.initials: L
authors.lastname: De Backer
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Backer
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001507:Beclomethasone / Q000008:administration & dosage*; D055745:Bronchioles / Q000187:drug effects*; D001995:Bronchography; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D000068759:Formoterol Fumarate; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents; D004983:Ethanolamines; D001507:Beclomethasone; D000068759:Formoterol Fumarate