TRIPLE THERAPY FOR ASTHMA

 

To breathe we do not need only air and lungs, but also the freedom. Yes, I actually support the above statement. How many of you think that you have the freedom to take a breath? The majority opinion for the restriction is, we humans itself and finally get diseased.

In respiratory medicine, the term overlap syndrome has been applied both to the association between obstructive sleep apnea and chronic obstructive pulmonary disease (COPD) and to patients with features of both asthma and COPD (asthma–COPD overlap syndrome – ACOS).  Asthma and COPD are major public health problems. Asthma is a condition in which the airways narrowed, swelled and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound when we breathe out and shortness of breath.

 COPD is defined as a common preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with enhanced chronic inflammatory responses in the airways and the lungs to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients. Certain studies have proved that asthma and COPD may coexist or at least one condition may evolve into the other creating a condition commonly described as Asthma COPD Overlap Syndrome. It is a syndrome in which older adults with a significant smoking history have features of asthma in addition to their COPD or non-smoking asthmatics have persistent airflow obstruction. According to GINA 2016, ACOS is characterized by persistent airflow limitation with several features usually associated with asthma and several features.

ACOS is characterized by TH2-mediated eosinophilic inflammation, bronchodilator reversibility and corticosteroid responsiveness in a COPD a subset, even in the absence of a clinical history of asthma. A subset of treated non-smokers with moderate to severe asthma has persistent expiratory airflow limitation, despite partial reversibility. This is attributed to large and especially small airway remodelling and recently the theory of reversible loss of lung elastic recoil leading to hyperinflation and centrilobular emphysema has been proposed. However, the mechanism(s) responsible for the loss of lung elastic recoil and persistent expiratory airflow limitation in non-smokers with chronic asthma consistent with ACOS remain unknown in the absence of structure-function studies. Both asthma and COPD are heterogeneous diseases and comprise various phenotypes.

The pharmacotherapeutics consideration requires an integrated approach, first to identify the relevant clinical phenotypes, then to determine the best available therapy.

 

Mild intermittent patients, those who have symptoms infrequently would benefit from as needed albuterol triple combination asthma medication would be most appropriate for moderate to severe asthmatic patients.  If symptoms become more persistent your doctor may use an inhaled steroid.  If the asthma is still not controlled, adding a LABA is an option.  If all of that doesn’t work, a combination medication like Trelegy would be a possibility. This medication would be most appropriate for moderate to severe asthmatic patients.   Triple therapy / Trelegy is approved for people with COPD, including those with chronic bronchitis and emphysema. It combines three inhaled COPD drugs: a corticosteroid to bring down the swelling in your airways, a long-acting beta-agonist to relax the muscles around your airway and an anticholinergic drug to widen the large airways. It is a new asthma medication by GlaxoSmithKline (GSK) is currently being developed for the treatment of asthma and COPD and consist of 3 medications, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI).   The medication will be delivered once daily as a dry powder inhaler.

There is an urgent need for more research on this topic, in order to guide better recognition and appropriate treatment. This should include a study of clinical and physiological characteristics, biomarkers, outcomes and underlying mechanisms, starting with broad populations of patients with respiratory symptoms or with chronic airflow limitation, rather than starting with populations with existing diagnoses of asthma or COPD.  Further research is needed to inform evidence-based definitions and a more detailed classification of patients who present overlapping features of asthma and COPD and to encourage the development of specific interventions for clinical use.

Ms. BENITA JOHN, III rd PHARM D