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Original Article
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Korean J Intern Med. 2025;40(3):491-501. Published online April 30, 2025.
DOI: https://doi.org/10.3904/kjim.2024.393
- Comparison of extrafine and non-extrafine inhaled corticosteroids/long-acting β2-agonists as maintenance and reliever therapy in asthma: a randomized open-label crossover trial
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Sang Pyo Lee1, Sang Min Lee2, Sung-Yoon Kang1
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1Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
2Division of Respiratory Disease and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
- Corresponding author: Sung-Yoon Kang ,Tel: +82-32-460-3201, Fax: +82-32-469-4320, Email: allergy4u@gmail.com
- Received: November 20, 2024; Revised: December 11, 2024 Accepted: December 30, 2024.
- Abstract
- Background/Aims
Asthma is characterized by chronic inflammation. Inhaled corticosteroids (ICS) remain the cornerstone of anti-inflammatory therapy, targeting both the large and small airways.
Methods
This randomized open-label crossover trial included 30 patients receiving step 3 inhaled medication according to the Global Initiative for Asthma (GINA). Patients received beclomethasone/formoterol (BDP/F) for maintenance and reliever therapy for 6 weeks, followed by budesonide/formoterol (BUD/F) for 6 weeks, or vice versa, with a 4-week washout period in between. Assessments at each visit included the Asthma Control Test (ACT), Asthma Control Questionnaire, Quality of Life Questionnaire for Adult Korean Asthmatics, and pulmonary function test. The primary endpoint was the change in forced expiratory flow between 25% and 75% of vital capacity (FEF25–75% pred).
Results
Twenty-four patients (15 females, mean age 39.3 years) completed the study. The changes in FEF25–75% pred were comparable between BDP/F and BUD/F (5.79 ± 38.34 vs. -1.36 ± 14.93, p = 0.399). No significant differences were observed between the BDP/F and BUD/F groups in terms of improvement in asthma control or quality of life. However, in the subgroup of patients with positive methacholine bronchial provocation tests, BDP/F significantly improved ACT scores compared to BUD/F (0.92 ± 2.25 vs. -1.31 ± 3.04, p = 0.044).
Conclusions
Our study demonstrated that extrafine ICS treatment provided no significant advantage over non-extrafine ICS in improving small airway obstruction or overall asthma control in moderate asthma. This suggests that factors other than particle size may contribute to treatment outcomes.
Keywords :Asthma; Beclomethasone; Budesonide; Forced expiratory flow between 25% and 75% of vital capacity; Treatment outcome
