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Article

Real-World Efficacy of Beclomethasone Dipropionate/Formoterol Fumarate/Glycopyrronium on Diaphragmatic Workload Assessed by Ultrasound and Lung Function in Patients with Uncontrolled Asthma

by
Antonio Maiorano
1,
Anna Ferrante Bannera
1,
Chiara Lupia
1,
Daniela Pastore
1,
Emanuela Chiarella
2,
Giovanna Lucia Piazzetta
2,
Angelantonio Maglio
3,
Alessandro Vatrella
3,
Girolamo Pelaia
1 and
Corrado Pelaia
2,*
1
Department of Health Sciences, Magna Graecia University, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy
2
Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy
3
Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
*
Author to whom correspondence should be addressed.
Adv. Respir. Med. 2025, 93(5), 40; https://doi.org/10.3390/arm93050040
Submission received: 29 August 2025 / Revised: 24 September 2025 / Accepted: 30 September 2025 / Published: 1 October 2025
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Abstract

Background: Uncontrolled asthma remains a significant clinical challenge, often linked to impaired lung function and increased diaphragmatic workload. Recent studies have shown promising results using a triple inhaled therapy comprising beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). This study assessed the real-world efficacy of BDP/FF/G on lung function and diaphragmatic workload in patients with uncontrolled asthma. Methods: A prospective observational study enrolled 21 adult patients diagnosed with uncontrolled asthma despite high-dose ICS/LABA therapy. Patients underwent lung function tests and right diaphragmatic ultrasound assessments at baseline and after three months of treatment with BDP/FF/G (172/5/9 mcg, administered as two inhalations every 12 h). Results: After three months, significant improvements were observed in FEV1 (from 57.75 ± 12.30% to 75.10 ± 18.94%, p < 0.001) and FEF25–75 (from 47.80 ± 19.23% to 75.10 ± 36.06%, p < 0.001). Additionally, during the same period, we recorded significant reductions in residual volume (from 130.10 ± 28.20% to 92.55 ± 21.18%, p < 0.001) and total airway resistance (Rtot) (from 164.60 ± 83.21% to 140.70 ± 83.25%, p < 0.05). The mean asthma control test (ACT) score increased by 5.6 points (p < 0.001), surpassing the established minimal clinically important difference (MCID) of 3 points and raising the cohort mean above the well-controlled threshold. The right diaphragmatic workload was significantly decreased, as shown by a reduction in thickening fraction (TF) (from 63.86 ± 17.67% to 40.29 ± 16.65%, p < 0.01). Correlation analysis indicated significant associations between diaphragmatic function and some lung function parameters (FEV1, FEF25–75, and Rtot). Conclusions: In this real-world pilot, triple BDP/FF/G was linked to improvements in airflow, hyperinflation, symptoms, and a reduction in diaphragmatic thickening fraction, indicating potential physiological benefit. Due to the small sample size, single-centre design, and 3-month follow-up, these results should be viewed as hypothesis-generating and need to be confirmed in larger, controlled, multicentre studies with longer follow-up.
Keywords: uncontrolled asthma; inhaled therapy; lung function; small airway disease; diaphragmatic function; thoracic ultrasound uncontrolled asthma; inhaled therapy; lung function; small airway disease; diaphragmatic function; thoracic ultrasound

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MDPI and ACS Style

Maiorano, A.; Ferrante Bannera, A.; Lupia, C.; Pastore, D.; Chiarella, E.; Piazzetta, G.L.; Maglio, A.; Vatrella, A.; Pelaia, G.; Pelaia, C. Real-World Efficacy of Beclomethasone Dipropionate/Formoterol Fumarate/Glycopyrronium on Diaphragmatic Workload Assessed by Ultrasound and Lung Function in Patients with Uncontrolled Asthma. Adv. Respir. Med. 2025, 93, 40. https://doi.org/10.3390/arm93050040

AMA Style

Maiorano A, Ferrante Bannera A, Lupia C, Pastore D, Chiarella E, Piazzetta GL, Maglio A, Vatrella A, Pelaia G, Pelaia C. Real-World Efficacy of Beclomethasone Dipropionate/Formoterol Fumarate/Glycopyrronium on Diaphragmatic Workload Assessed by Ultrasound and Lung Function in Patients with Uncontrolled Asthma. Advances in Respiratory Medicine. 2025; 93(5):40. https://doi.org/10.3390/arm93050040

Chicago/Turabian Style

Maiorano, Antonio, Anna Ferrante Bannera, Chiara Lupia, Daniela Pastore, Emanuela Chiarella, Giovanna Lucia Piazzetta, Angelantonio Maglio, Alessandro Vatrella, Girolamo Pelaia, and Corrado Pelaia. 2025. "Real-World Efficacy of Beclomethasone Dipropionate/Formoterol Fumarate/Glycopyrronium on Diaphragmatic Workload Assessed by Ultrasound and Lung Function in Patients with Uncontrolled Asthma" Advances in Respiratory Medicine 93, no. 5: 40. https://doi.org/10.3390/arm93050040

APA Style

Maiorano, A., Ferrante Bannera, A., Lupia, C., Pastore, D., Chiarella, E., Piazzetta, G. L., Maglio, A., Vatrella, A., Pelaia, G., & Pelaia, C. (2025). Real-World Efficacy of Beclomethasone Dipropionate/Formoterol Fumarate/Glycopyrronium on Diaphragmatic Workload Assessed by Ultrasound and Lung Function in Patients with Uncontrolled Asthma. Advances in Respiratory Medicine, 93(5), 40. https://doi.org/10.3390/arm93050040

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