Asthma control in patients on fixed dose combination evaluated with mannitol challenge test

Area of Science:

• Pulmonology
• Allergy and Immunology

Background:

• Asthma management remains challenging, with many patients not achieving optimal control.
• Fixed-dose combination (FDC) therapies are commonly prescribed for asthma.
• Assessing asthma control beyond patient-reported outcomes is crucial.

Purpose of the Study:

• To evaluate asthma control in adults using FDC therapy.
• To compare the efficacy of the mannitol challenge test versus the asthma control test (ACT) in monitoring asthma control.
• To identify predictors of airway hyperresponsiveness in patients on FDC therapy.

Main Methods:

• An open-label, prospective study involving 98 adults on FDC therapy for at least three months.
• Asthma control assessed using the mannitol challenge test and the ACT.
• Spirometry parameters and comorbid conditions were analyzed as potential predictors.

Main Results:

• While 74% of patients reported good asthma control, 65% showed a positive mannitol challenge test, indicating airway hyperresponsiveness.
• FEV1/FVC and FEV1% of predicted were significant predictors of a positive mannitol challenge test.
• Comorbidities like upper airway involvement or eczema did not predict mannitol reactivity.

Conclusions:

• A significant proportion of adult asthma patients on FDC therapy exhibit underlying airway inflammation, despite self-reported well-controlled asthma.
• The mannitol challenge test provides valuable insights into subclinical airway inflammation.
• Current FDC therapies may not fully address underlying inflammation in all asthma patients.