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Original Research

Effect of triple therapy in patients with asthma-COPD overlap 

Yoshihisa Ishiura, Masaki Fujimura, Noriyuki Ohkura, Johsuke Hara, Kazuo Kasahara, Nobuyasu Ishii, Takeshi Tamaki, Toshiki Shimizu, and Shosaku Nomura

Volume 57 (2019) p. 384 - 392

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 57 – No. 8/2019 (384-392)

Effect of triple therapy in patients with asthma-COPD overlap 

Yoshihisa Ishiura¹#², Masaki Fujimura³, Noriyuki Ohkura⁴, Johsuke Hara⁴, Kazuo Kasahara⁴, Nobuyasu Ishii¹, Takeshi Tamaki¹, Toshiki Shimizu¹, and Shosaku Nomura¹

¹First Department of Internal Medicine, Kansai Medical University, Osaka, ²Respiratory Medicine, Toyama City Hospital, Toyama, ³Respiratory Medicine, National Hospital Organization Nanao Hospital, Nanao, and ⁴Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
Objective: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is of increasing interest because ACO patients have significantly worse outcomes, leading to greater social and economic burdens compared with asthma or COPD alone. Some guidelines for ACO recommend triple therapy with inhaled corticosteroids, long-acting β2 agonists, and long-acting muscarinic antagonists. However, this approach is based on extrapolating data from patients with asthma or COPD alone. Therapeutic studies for ACO have not previously been conducted. Materials and methods: A 12-week, randomized, open-label cross-over pilot study was conducted in 17 ACO patients to evaluate the effect of umeclidinium (UMEC) 62.5 µg once-daily added to fluticasone furoate/vilanterol (FF/VI) 200/25 µg once-daily. A 4-week run-in, a first and a second 4-week treatment period were included. Respiratory function, respiratory impedance, fractional exhaled nitric oxide, COPD assessment test, and asthma control test scores were evaluated 0, 4, and 8 weeks after randomization. Results: Mean values of post-bronchodilator forced expiratory volume in 1 second as a percentage of the predicted value (%FEV₁), after UMEC was added to FF/VI, were significantly higher than after the run-in (p < 0.01). Mean values of resonant frequency during inspiration (Fres), after UMEC was added to FF/VI, were significantly lower than after the run-in (p < 0.01). Conclusion: Adding UMEC to FF/VI provides greater improvement in lung function, indicating that triple therapy is a suitable regular treatment for ACO.Correspondence to:
 Yoshihisa Ishiura, MD
First department of Internal Medicine
Kansai Medical University Medical Center
10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan
Email: ishiura-@ p2322.nsk.ne.jp

Original

Can tiotropium add-on inhalation revolutionize therapy in elderly asthmatic patients? A treatable traits approach towards successful aging 

Yoshihisa Ishiura, Shosaku Nomura, Noriyuki Ohkura, Johsuke Hara, Masaki Fujimura, and Tomoki Ito

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Volume 64 (2026) p. 296 - 303

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 64 – No. 6/2026 (296-303)

Can tiotropium add-on inhalation revolutionize therapy in elderly asthmatic patients? A treatable traits approach towards successful aging 

Yoshihisa Ishiura¹#², Shosaku Nomura¹#², Noriyuki Ohkura³, Johsuke Hara³, Masaki Fujimura³, and Tomoki Ito¹#²

¹First Department of Internal Medicine, ²Respiratory Medicine, Kansai Medical University Medical Center, Osaka, and ³Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
Background: The population of elderly patients with asthma is increasing, resulting in serious health problems because of hospitalization and high mortality rate. Furthermore, several recent studies have shown that progressive airflow limitation may worsen cognitive dysfunction and contribute to poor asthma control. Maintaining good respiratory function is therefore important in the elderly in order to achieve a satisfactory quality of life.
Materials and methods: A 12-week, open-label, cross-over study was conducted in elderly patients with asthma to investigate the effect of 5 μg/day tiotropium bromide (TIO) add-on therapy administered using a soft mist inhaler (SMI), in addition to a dosage of 500/20 µg/day fluticasone propionate/formoterol fumarate (FP/FM) treatment and to compare the effects of treatment with those following the administration of 500/20 µg/day FP/FM alone. The trial design thus entailed a 4-week run-in period and two 4-week treatment periods.
Results: A total of 21 patients aged over 65 years with stable bronchial asthma were recruited in the study. Forced expiratory volume in 1 second values after the treatment period with FP/FM and TIO add-on therapy were significantly higher than those after the run-in period (p < 0.01).
Conclusion: TIO add-on therapy FP/FM treatment using an SMI in elderly patients with asthma improved lung function parameters demonstrating, the value of TIO add-on therapy as a treatable traits option for improving quality of life and achieving successful aging in this population.Correspondence to:
Yoshihisa Ishiura, MD
First Department of Internal Medicine
Kansai Medical University
10-15 Fumizono-cho, Moriguchi,
Osaka, 570-8507, Japan
Email: [email protected]

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