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Guideline
. 2022 Sep 29;90(5):407-424.
doi: 10.3390/arm90050051.

ICS/Ultra LABA in the Treatment of Obstructive Airway Diseases: A Consensus of Indian Experts

Raja Dhar  1 , Deepak Talwar  2 , Prince James  3 , Ashwini Mishra  4 , Judo Vachaparambil  5 , Saiprasad Patil  6 , Nishtha Khatri  6 , Sagar Bhagat  6 , Hanmant Barkate  6
Affiliations
Guideline

ICS/Ultra LABA in the Treatment of Obstructive Airway Diseases: A Consensus of Indian Experts

Raja Dhar et al. Adv Respir Med. .

Abstract

Inhaled corticosteroid and ultra-long-acting beta-agonist (ICS/uLABA) combination is a recent advancement in the armamentarium against obstructive airways diseases (OADs). The combination of ICS/uLABA has several advantages, creating a favorable landscape for its utilization. Fluticasone furoate/vilanterol trifenatate (FF/Vi) is one such example of an ICS/uLABA. It offers several benefits from both drugs, such as a convenient once daily dosing schedule; high lipophilicity; high receptor affinity of fluticasone furoate along with high functional selectivity and a quick onset of action of vilanterol. However, the Global Initiative for Asthma (GINA) as well as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines do not clearly define the positioning of ICS/uLABA compared to conventional ICS/LABAs. There are a few areas of uncertainty especially around the appropriate reliever strategy with ICS/uLABA in Asthma. The current consensus was planned with a group of Indian pulmonology experts to provide more clarity on the potential use of FF/Vi in Asthma and COPD. The clinical statements highlighted in this consensus manuscript address crucial clinical questions revolving around the efficacy and safety of FF/Vi as compared to conventional ICS/LABAs and identify the ideal patient profile for its use. This consensus paper also sheds light upon the appropriate reliever to be used along with FF/Vi in Asthma and the utilization of FF/Vi-based triple therapy in OADs. Expert recommendations mentioned in this paper will serve as guidance to pulmonologists as well as consultant physicians who are involved in providing care to OAD patients and will help them weigh the various factors that need to be taken into account while prescribing ICS/uLABA combination.

Keywords: Asthma; COPD; FF/Vi; ICS/ultra LABA; consensus; fluticasone furoate; vilanterol.

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Conflict of interest statement

R. Dhar has nothing to disclose. D. Talwar has nothing to disclose. P. James has nothing to disclose. A Mishra has nothing to disclose. J. Vachaparambil has nothing to disclose. S. Patil is an employee of Glenmark Pharmaceuticals Ltd. N. Khatri is an employee of Glenmark Pharmaceuticals Ltd. S. Bhagat is an employee of Glenmark Pharmaceuticals Ltd. H. Barkate is an employee of Glenmark Pharmaceuticals Ltd.

Figures

Figure 1
Figure 1
Stepwise consensus development process.
Figure 2
Figure 2
Various steps of GINA 2021 guidelines where use of uLABA/ICS can be considered.
Figure 3
Figure 3
Potential use of FF/Vi in the various GOLD 2021 categories of COPD patients. mMRC: Modified Medical Research Council Dyspnea Scale; CAT: COPD Assessment Test.
See this image and copyright information in PMC

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