Abstract
It has become apparent that bronchial asthma (asthma) does not affect only the larger airways, but that small airways are also significantly involved. So far the study of the biology, pathology and function of the small airways has been relatively limited in patients in vivo.
At present, thanks to a number of technologies, we have entered the process of becoming familiar with the molecular, morphological and physiological aspects of the small airways, putting us in the position to gradually put together a complex and multicoloured mosaic of how the small airways influence the pathogenesis, diagnostics, phenotyping and clinical course of asthma, eventually influencing targeted pharmacotherapy. A significant shift in the current asthma pharmacotherapy is undoubtedly the new fixed combination of beclometasone dipropionate/formoterol fumarate (BDP/formoterol) in the form of an aerosol delivery system (MDI), employing the propellant gas hydrofluoroalkane (HFA) and a new Modulite technology (MDI-HFA-Modulite).
This technology creates very small (superfine) inhaled particles with mass median aerodynamic diameters (MMADs) of 1.4 μm (BDP) and 1.5 μm (formoterol). This allows homogeneous distribution in both central and peripheral sections of the bronchial tree.
The deposition value of the respirable fraction was 38.6% of the delivered dose for formoterol and 39.7% of the delivered dose for BDP. As a result of this high pulmonary deposition of BDP associated with this technology it is possible to reduce the equivalent nominal dose of BDP to 100 μg, which is equivalent to 250 μg of BDP MDI-CFC (chlorofluorocarbon).
This reduces the systemic exposure to BDP and increases the safety of administration of inhaled corticosteroids. The new combination BDP/formoterol has been registered in the Czech Republic since 2007 in the dose 100/6 μg.
It is currently indicated for the treatment of individuals older than 12 years of age diagnosed with persisting asthma who could not be controlled with inhaled corticosteroid monotherapy or with separately administered components of the combination of a corticosteroid and a long-acting β2-agonist. Clinical studies have shown a better asthma control with the new combination preparation BDP/formoterol MDI-HFA-Modulite compared to the same drugs when administered separately, as well as the equivalence of the clinical effect with other fixed combinations marketed in the Czech Republic (budesonide/formoterol and fluticasone/salmeterol)