Efficacy of Inhaler Devices in New-Onset Mild Asthma: A Randomized Blinded Multicenter Trial

Area of Science:

• Pulmonology
• Respiratory Medicine
• Pharmacology

Background:

• Low-dose inhaled corticosteroids (ICS) are standard for mild bronchial asthma.
• Efficacy of pressurized metered-dose inhalers (pMDI) versus dry powder inhalers (DPI) in mild asthma is less established than in moderate-to-severe cases.

Purpose of the Study:

• To evaluate and compare the efficacy of ICS-pMDI versus ICS-DPI in patients newly diagnosed with mild asthma.

Main Methods:

• A 4-week, multicenter, randomized study involving 156 patients with newly diagnosed mild asthma.
• Participants received either ICS-pMDI or ICS-DPI.
• Evaluations included lung function (FEV1, FVC, FEF50%, FEF25-75%), asthma control test (ACT) scores, and blood eosinophil (EOS) counts.

Main Results:

• ICS-pMDI significantly improved large airway parameters (FEV1, FVC) and small airway function (FEF50%, FEF25-75%) compared to ICS-DPI.
• Greater absolute improvement in FEV1 was observed with ICS-pMDI, particularly in patients with baseline small airway dysfunction (SAD) or elevated EOS.
• Both inhaler types demonstrated comparable improvements in ACT scores, EOS reduction, exacerbation rates, and adverse events.

Conclusions:

• A 4-week ICS-pMDI treatment effectively improves both large and small airway function in newly diagnosed mild asthma.
• ICS-pMDI offers comparable symptom control and inflammation reduction to ICS-DPI, with a similar safety profile.
• Baseline SAD, elevated EOS levels, and FEV1 reversibility may predict ICS-pMDI effectiveness in enhancing airway function.