Managing Small Airway Disease in patients with severe asthma: transitioning from the "Silent Zone" to achieving "Quiet Asthma"

<bold>Background:</bold> Several studies have demonstrated the positive clinical and functional impact of adding Long-Acting Muscarinic Antagonist (LAMA) to Inhaled Corticosteroids (ICS) and Long-Acting Beta-Agonists (LABA) therapy in the treatment of severe asthma. <bold>Aims and Objectives:</bold> To demonstrate that treating Small Airways Disease (SAD) in severe asthma patients candidate to biologics can improve respiratory symptoms, lung function and airways inflammation, potentially avoiding or delaying the use of biological therapy. <bold>Methods:</bold> Thirty-two severe asthma patients with SAD were transitioned from separate inhalers for ICS/LABA and LAMA to extrafine single-inhaler beclomethasone, formoterol, and glycopyrronium. None of these underwent biological therapy before the study. Follow-up evaluations were conducted at baseline (T0) and three months after initiation (T1). Assessments included clinical evaluations, spirometry, oscillometry, and inflammation markers. <bold>Conclusions:</bold> Adopting a single-inhaler triple therapy notably enhanced clinical control and small airway function in patients with severe asthma and SAD, supporting the positive impact of target-therapy for the achievement of a stable state termed “Quiet Asthma”.