News in brief: Triple therapy in single inhaler on the PBS; Mapping where coronavirus travels in the lungs; Update on COPD burden

Wednesday, 16 Jun 2021

Trimbow now available on the PBS for COPD

The triple therapy inhaler Trimbow (beclometasone dipropionate 100 µg, formoterol fumarate dihydrate 6 µg and glycopyrronium 10 µg) has been added to the PBS for the treatment of moderate to severe COPD requiring a step up from dual therapy.

Professor Frank Thien, director of respiratory medicine at Eastern Health and Monash University, said in a statement from Chiesi that a single inhaler with triple agents can also simplify the treatment for patients switching from ICS+LABA+LAMA in multiple inhalers.

“In the case of Trimbow, the additional advantage of extrafine particle size affords greater lung penetration and deposition compared with larger particle inhalers,” he said.

Observational studies funded by Chiesi – here and here – have shown that switching from triple therapy in multiple inhalers to extrafine Trimbow improved health related quality of life and adherence to therapy.

The clinical benefit of the difference in particle lung deposition has not been demonstrated in head-to-head clinical trials.

Mapping the flow of coronavirus in the lungs

Researchers have modelled the likely flow of the coronavirus into the terminal airways of the respiratory system.

A computational fluid dynamics investigation of virus aerosol transport in a digital model of the human airways found SARS CoV-2 aerosol deposition was higher on the right side of the lung compared to the left side for all airflow rates.

“The concentration curve shows the SARS CoV-2 aerosol deposition concentration is found to be higher at the upper as well as middle bifurcations of the 17-generation model.”

However the deposition hot spot in the left lung includes the lower lobes but varies with airflow rates.

“The results of this study provide a precise knowledge of the SARs CoV-2 particle transport to the lower branches and could help the lung health risk assessment system,” the researchers said.

Physics of Fluids

COPD burden in Australia updated

The prevalence estimate of all COPD is 8.30% for Australian adults aged 40 or more years, according to an update of the Burden of Obstructive Lung Disease study.

The COPD burden includes 2.52% with mild breathlessness, 0.99% with moderate breathlessness and 0.91% with severe breathlessness.

As expected, COPD gradually increased with age and was about five times more common in those aged 75 or more years than in 40-44 years olds.

COPD with mild breathlessness – cough and shortness of breath after heavy physical activity, but able to walk long distances and climb stairs – was more common in men than women.

However COPD with moderate breathlessness – cough, wheezing and shortness of breath, even after light physical activity. Feels tired and can walk only short distances or climb only a few stairs – was more common in women than men.

The prevalence of COPD with severe breathlessness – cough, wheezing and shortness of breath all the time. Has great difficulty walking even short distances or climbing any stairs, feels tired when at rest and is anxious – was similar in men and women.

“Up-to-date information about the prevalence and distribution of COPD in Australia will enable better planning and resource allocation to address this substantial ongoing health challenge,” the study said.

Internal Medicine Journal


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