What question did this study set out to answer?

To evaluate the impact of precision bronchodilator therapy on lung function and responsiveness in asthmatics.

May 6, 2026Lung India0 citationsOpen Access

The precision bronchodilator therapy in airflow limitation with asthma defining reversibility: An appraisal through pharmaco-responsiveness-based real-world observation

PBParthasarathi Bhattacharyya SSSrijita Sen SGShuvam Ghosh

Key Points

To evaluate the impact of precision bronchodilator therapy on lung function and responsiveness in asthmatics.
Conducted an open, randomised observation among asthmatics.
Used spirometry and the 2-Chair test to assess bronchodilator-responsiveness.
Compared treatment effects between two groups: one with BDR and another with BDR and GPR.
Both treatment groups showed overall improvements in lung function.
The GPR-positive group had significantly higher FEV1 post-treatment compared to BDR-only.
No serious adverse events were reported during the treatment.

Abstract

Background: The advent of glycopyrronium responsiveness (GPR) has opened an avenue for precision bronchodilator therapy in asthmatics. Methods: We noted 2-Chair test (2CT) and spirometry with salbutamol bronchodilator-responsiveness (BDR) followed immediately by GPR in a cohort of asthmatics in an open, randomised observation. We treated (GINA stage-2 and 3) asthmatics with long-acting β2-agonist plus inhaled-corticosteroid (LABA-ICS) for salbutamol-BDR and with inhaled triple therapy (LABA-LAMA-ICS) for those having BDR and GPR. We compared the spirometry and 2-chair tests statistically between the initial and the follow-up status. Results: The two groups (30 each) were similar in demographic (age, body mass index), spirometric, and 2CT parameters. Post treatment (346.2 ± 242.3 and 390.2 ± 212.6 days for BDR and BDR+GPR-positive cases), both the groups improved universally. The GPR-positive triple drug treated group had similar change (215.7 ± 346.1 vs. 161.3 ± 318.7, P = 0.1578) in trough FEV1 but had a significantly higher value for post-salbutamol (449.0 ± 209.0 vs. 348.7 ± 282.2; P = 0.0201) and post-GP (531.7 ± 248.7 vs. 348.7 ± 282.2; P = 0.0015) FEV1 values on follow-up. The patients accepted the triple therapy universally without any serious adverse events. The two groups had similar number of mild exacerbations. Conclusions: The pharmaco-responsiveness based add-on LAMA is seen to improve lung function of asthma in early GINA stages with parallel, though not significant, changes in the post-exercise recovery response (Desat-max in 2CT). The observation demands attention to consider upfront prescription of LAMA based on universal performance of GP responsiveness in asthma.

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