This document discusses new inhaler combinations for treating asthma. It summarizes several clinical studies that evaluated the efficacy of combining inhaled corticosteroids and long-acting muscarinic antagonists to control asthma symptoms. One study of over 5,000 patients found that combining these drugs reduced the risk of exacerbations compared to inhaled corticosteroids alone. The document also references guidelines from GINA that recommend stepwise treatment with inhaled corticosteroids and adding long-acting beta-agonists or tiotropium for uncontrolled asthma.

1. ASMAALLERGIE
10 Novembre 2018
Nuove associazioni inalatorie nella terapia
dell’asma bronchiale
Dott. B.POLLA
SOC Malattie Apparato Respiratorio Alessandria

4. Farmaci « biologici»
Zhu, 2018

5. STUDI CLINICI

6. Realta’

10. Dal Negro 2015

12. 5000 pz

13. 20% 47% 23%3.660
29.7% 44% 20.2%DPI d
19.7%
13.7%
50%
44%
21.2%
25.2%
DPI th
MDI
0 errori
3-4 errori
1-2 errori
> 4 errori

16. K-HALER

19. © Global Initiative for Asthma www.ginasthma.org
Stepwise management - pharmacotherapy
*Not for children <12 years
**For children 6-11 years, the
preferred Step 3 treatment is
medium dose ICS
#For patients prescribed
BDP/formoterol or BUD/
formoterol maintenance and
reliever therapy
 Tiotropium by mist inhaler is
an add-on treatment for
patients ≥12 years with a
history of exacerbations
Diagnosis
Symptom control & risk factors
(including lung function)
Inhaler technique & adherence
Patient preference
Asthma medications
Non-pharmacological strategies
Treat modifiable risk factors
Symptoms
Exacerbations
Side-effects
Patient satisfaction
Lung function
Other
controller
options
RELIEVER
STEP 1 STEP 2
STEP 3
STEP 4
STEP 5
Low dose ICS
Consider low
dose ICS
Leukotriene receptor antagonists (LTRA)
Low dose theophylline*
Med/high dose ICS
Low dose ICS +
LTRA
(or + theoph*)
As-needed short-acting beta2-agonist (SABA) As-needed SABA or
low dose ICS/formoterol#
Low dose
ICS/LABA**
Med/high
ICS/LABA
PREFERRED
CONTROLLER
CHOICE
Add tiotropium*
Med/high dose
ICS + LTRA
(or + theoph*)
Add low
dose OCS
Refer for
add-on
treatment
e.g.
tiotropium,*
anti-IgE,
anti-IL5*
GINA 2018, Box 3-5 (2/8) (upper part)

20. Thompson 2017

22. Bateman,2016

23. EFFICACIA e AFFINITA’

24. EFFICACIA e AFFINITA’

27. Sobieraj DM, Baker WL, Nguyen E, et al.
Association of Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists With Asthma Control
in Patients With Uncontrolled, Persistent Asthma: A Systematic Review and Meta-analysis.
JAMA. 2018;319(14):1473-1484.

34. 205715 A Phase III, randomized, double-blind, active controlled, parallel
group study, comparing the efficacy, safety and tolerability of the fixed dose
combination FF/UMEC/VI with the fixed dose dual combination of FF/VI,
administered once-daily via a dry powder inhaler in subjects with
inadequately controlled asthma
207236 A Phase III, 52-week, Open-label Study to Evaluate Long-term Safety
of Fixed Dose Combination Therapy Fluticasone Furoate/Umeclidinium
Bromide/Vilanterol Trifenatate in Japanese Patients with Asthma

35. Diego et 2018
RESVERATROLO

36. RESVERATROLO
Lee 2017

37. GRAZIE
Vino (di origine
spagnola)
Resveratrol
o totale
(mg/L)
Dose
giornaliera di
vino
equivalente a
50 mg (*) di
resveratrolo (L)
Vino bianco 0,05-1,80 27,7-1000
Vino rosato 0,43-3,52 14,2-116,3
Vino rosso 1,92-12,59 4-26,0
Succo d'uva
rossa
1,14-8,69 5,7-43,9