ERS Respiratory Channel

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Abstract

Does the type of inhaler matter in cough variant- and cough predominant asthma?

Background

In cough variant- and cough predominant asthma (CVA and CPA) inhaled aerosol or dry powder may tease upper airway and induce cough what may have a negative impact on the efficacy of anti-asthmatic therapy.

Aim

to analyze if the type of inhaler (Dry Powder Inhaler, DPI vs pressurized Meter Dose Inhaler, MDI) affects the efficacy of CVA and CPA treatment.

Methods

Twenty-one adults (18F, 3M) with moderate asthma (median age 64 yrs, median asthma duration 5 yrs) were included in this prospective, non-randomized, cross-over study (NCT04203472). All patients were treated with formoterol and budesonide in either DPI or MDI with a switch from one to the other after 2 weeks. Inhalation technique training was provided upon each inhaler switch. The number of inhalation mistakes, asthma control, cough severity and cough related quality of life (measured by ACQ, VAS and LCQ respectively) were checked after 2 weeks of therapy with formoterol and budesonide in both DPI and MDI.

Results

Initially, 8 asthmatics used MDI and 13 DPI. There were no differences between MDI and DPI users in terms of age, asthma control or duration, cough severity and cough related quality of life or number of inhaler mistakes. Upper airway side effects were comparably frequent in DPI and MDI users. Inhaler switch led to improvement in asthma control in both groups. Additionally, changing MDI for DPI led to reduction of cough severity measured by VAS (?VAS from 42 to 18 mm, p=0.0005) and improvement of quality of life (? LCQ from 13.6 to 17.3, p=0.0034).

Conclusions

MDI and DPI were equally effective in the treatment of patients with CVA or CPA, but changing the inhaler combined with inhalation training may lead to better asthma control.

Abstract

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