Novel functional imaging of changes in small airways of patients treated with extrafine beclomethasone/formoterol

Respiration. 2013;86(5):393-401. doi: 10.1159/000347120. Epub 2013 Apr 12.


Background: Inhaled formulations using extrafine particles of long-acting β2-agonists and corticosteroids were developed to optimize asthma treatment. Findings that these combinations reach and treat smaller airways more effectively are predominantly based on general non-specific outcomes with little information on regional characteristics.

Objectives: This study aims to assess long-term effects of extrafine beclomethasone/formoterol on small airways of asthmatic patients using novel functional imaging methods.

Methods: Twenty-four stable asthma patients were subdivided into three groups (steroid naive, n = 7; partially controlled, n = 6; well controlled, n = 11). Current treatment was switched to a fixed combination of extrafine beclomethasone/formoterol (Foster®; Chiesi Pharmaceuticals, Parma, Italy). Patients underwent lung function evaluation and thorax high-resolution computerized tomography (HRCT) scan. Local airway resistance was obtained from computational fluid dynamics (CFD).

Results: After 6 months, the entire population showed improvement in pre-bronchodilation imaging parameters, including small airway volume (p = 0.0007), resistance (p = 0.011), and asthma control score (p = 0.016). Changes in small airway volume correlated with changes in asthma control score (p = 0.004). Forced expiratory volume in 1 s (p = 0.044) and exhaled nitric oxide (p = 0.040) also improved. Functional imaging provided more detail and clinical relevance compared to lung function tests, especially in the well-controlled group where only functional imaging parameters showed significant improvement, while the correlation with asthma control score remained.

Conclusions: Extrafine beclomethasone/formoterol results in a significant reduction of small airway obstruction, detectable by functional imaging (HRCT/CFD). Changes in imaging parameters correlated significantly with clinically relevant improvements. This indicates that functional imaging is a useful tool for sensitive assessment of changes in the respiratory system after asthma treatment.

MeSH terms

  • Adrenergic beta-2 Receptor Agonists / administration & dosage*
  • Adult
  • Aged
  • Anti-Asthmatic Agents / administration & dosage*
  • Asthma / diagnostic imaging
  • Asthma / drug therapy*
  • Beclomethasone / administration & dosage*
  • Bronchioles / drug effects*
  • Bronchography
  • Ethanolamines / administration & dosage*
  • Female
  • Formoterol Fumarate
  • Humans
  • Hydrodynamics
  • Male
  • Middle Aged
  • Respiratory Function Tests
  • Tomography, X-Ray Computed


  • Adrenergic beta-2 Receptor Agonists
  • Anti-Asthmatic Agents
  • Ethanolamines
  • Beclomethasone
  • Formoterol Fumarate