PT  - JOURNAL ARTICLE
AU  - Walter Giorgio Canonica
AU  - J. Christian Virchow
AU  - David Singh
AU  - Maxim Kots
AU  - Florence Zuccaro
AU  - Andrea Vele
AU  - George Georges
AU  - Stefano Petruzzelli
TI  - Effect of high extrafine strength (HS) ICS-containing triple therapy on exacerbations in patients with severe asthma and persistent airflow limitation: Post-hoc analysis of the TRIGGER study
AID  - 10.1183/13993003.congress-2019.OA5339
DP  - 2019 Sep 28
TA  - European Respiratory Journal
PG  - OA5339
VI  - 54
IP  - suppl 63
4099  - http://erj.ersjournals.com/content/54/suppl_63/OA5339.short
4100  - http://erj.ersjournals.com/content/54/suppl_63/OA5339.full
SO  - Eur Respir J2019 Sep 28; 54
AB  - Introduction: Persistent airflow limitation (PAL) may predict a positive clinical response to add-on long-acting muscarinic antagonist (LAMA) in asthmatics on inhaled corticosteroids and long-acting β2-receptor agonists (ICS/LABA)Objectives: We evaluated the effect of extrafine HS beclometasone dipropionate/formoterol fumarate/glycopyrronium bromide (BDP/FF/GB) on asthma exacerbations in a subset of patients with PALMethods: TRIGGER was a phase III randomized, parallel group trial comparing 52-week treatment with BDP/FF/GB 800/24/50 µg/d to BDP/FF 800/24 µg/d via pressurized metered dose inhalers (pMDI) and open-label treatment consisting of BDP/FF plus tiotropium Respimat® 5 μg/d (TioR) in adult patients with uncontrolled asthma on high-dose ICS/LABA and a history of exacerbation in the past year. PAL criteria were FEV1 ≤80% of predicted normal and FEV1/FVC ≤0.7 after 400 μg salbutamol pMDIResults: 1437 subjects were randomized in 2:2:1 ratio; 880 (61.2%) met PAL criteria on BDP/FF/GB (n=357), BDP/FF (n=346), and BDP/FF+TioR (n=177), respectively. Treatment of this subgroup with BDP/FF/GB compared to BDP/FF resulted in a 25.9% and 31.8% reduction in annual moderate-severe and severe asthma exacerbations rates, respectively, (RR [95% CI] = 0.741 [0.611, 0.900], p=0.002; 0.682 [0.494; 0.940], p=0.019), vs. 12% and 20.5% reductions in the entire study population. There were no significant differences between BDP/FF/GB and BDP/FF+TioR.Conclusions: PAL is associated with a greater response to triple therapy with extrafine HS BDP/FF/GB in patients with asthma uncontrolled on high dose ICS/LABAFootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, OA5339.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).