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

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.