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RESEARCH PRODUCT

Lung deposition of extrafine vs non-extrafine triple therapies in patients with COPD using Functional Respiratory Imaging (FRI)

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Introduction: FRI is a validated computational fluid dynamics (CFD)-based technique using aerosol delivery performance profile, patients’ high-resolution lung CT scans and patient-derived inhalation profiles to simulate aerosol lung deposition. Aims and Objectives: To evaluate lung deposition patterns of extrafine beclometasone dipropionate/formoterol fumarate/glycopyrronium [BDP/FF/G; TRIMBOW®] pressurized metered dose inhaler (pMDI) and non-extrafine fluticasone furoate/vilanterol/umeclidinium [FluF/VI/UMEC; TRELEGY® ELLIPTA®] dry powder inhaler (DPI) in patients with stable COPD and moderate to very severe airflow obstruction. Methods: Intrathoracic depositions of the inhaled corticosteroid (ICS), long-acting β2 receptor agonist (LABA), and long-acting muscarinic antagonist (LAMA) components were calculated for each inhaler in 20 patients. Inhalation was simulated in silico using a per-patient profile derived from real life measurement. Results: Pulmonary deposition [% delivered dose] was higher for extrafine BDP than FluF (35.9 ± 6.7% vs 23.3± 4.6%) and comparable between FF and VI and between G and UMEC. Central to peripheral ratios were markedly lower for BDP, FF, and G compared to FluF, VI and UMEC, respectively (Table 1). Conclusions: FRI data indicate a higher peripheral lung (small airways) deposition with extrafine BDP/FF/G than with FluF/VI/UMEC. This may be attributed to the lower Mass Median Aerodynamic Diameter (MMAD) of BDP/FF/G.