Extra-Fine Single-Inhaler Triple Therapy useful for Severe Asthma with small airways dysfunction, may delay need for biological therapies: Study
China: Severe asthma remains a major healthcare challenge, contributing to increased morbidity, reduced quality of life, and higher healthcare costs. One of the key factors influencing disease severity is small airways dysfunction (SAD), which affects the distal airways measuring less than 2 mm in diameter. These airways account for nearly 98.8% of the lung volume and significantly contribute to airway resistance in asthma.
Recent research published in the Journal of the Formosan Medical Association has highlighted that SAD is present across all levels of asthma severity. However, its impact is particularly pronounced in severe cases. The greater the degree of dysfunction in the small airways, the poorer the asthma control and the higher the likelihood of exacerbations. As a result, targeted therapies focusing on small airways dysfunction are crucial for optimizing asthma management.
The research revealed that one of the promising treatment strategies is extra-fine single-inhaler triple therapy, which combines inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and long-acting muscarinic antagonists (LAMA). This approach ensures improved drug delivery to the small airways while also benefiting the larger airways, leading to better asthma control. Evidence suggests that this therapy may also delay the need for biological treatments in individuals with severe asthma.
For patients requiring advanced treatment options, biological therapies have emerged as an effective approach. While direct comparative studies from randomized controlled trials (RCTs) are still limited, recent findings indicate that biologics not only help in managing severe asthma but also show potential benefits for SAD. Most available biologics primarily target type 2 inflammation, which is a dominant pathway in severe asthma. However, not all patients with SAD fall into the type 2-high category, necessitating alternative treatment options.
In such cases, bronchial thermoplasty (BT), a non-pharmacological intervention, has been considered. This procedure reduces airway smooth muscle mass and primarily targets large airways, but emerging evidence suggests it may also benefit small airways dysfunction. BT may be particularly useful for individuals with severe asthma who do not respond adequately to type 2-targeted biologic therapies.
"Given the significant role of small airways dysfunction in asthma severity, incorporating SAD assessment into routine clinical practice is essential. Identifying small airway impairment early can help clinicians tailor treatment strategies more effectively," Yaqing Xu, Department of Geriatric Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China, and colleagues wrote.
"Future research should focus on validating the role of SAD-targeted therapies, exploring new biologic treatments, and determining the long-term benefits of interventions like bronchial thermoplasty in patients with severe asthma," they concluded.
Reference:
Deng, N., Xianyu, Y., Xu, Y., & Nie, H. (2025). Small airways dysfunction in severe asthma: Current treatment approaches and future directions. Journal of the Formosan Medical Association. https://doi.org/10.1016/j.jfma.2025.01.021
Recent studies suggest that extra-fine single-inhaler triple therapy can significantly improve severe asthma (SAD) control. This advanced treatment may help delay the need for costly and intensive biological therapies in severe asthma patients. By enhancing airway function and reducing inflammation, this therapy offers a promising alternative for better disease management.
