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Synthetic lung surfactant inhalation improves bronchial asthma

HOUSTON — New data from Russia indicate that patients with bronchial asthma experienced significant improvement in clinical symptoms and lung function parameters after treatment with inhaled synthetic lung surfactant in addition to inhaled corticosteroids.

“Surfactant ensures normal respiratory mechanics, respiratory passage regulation, protects the lungs from damage due to physical or chemical agents and is also part of the immune response,” Lawrence M. DuBuske, MD, from the George Washington University School of Medicine in Washington, D.C., said at the American College of Allergy, Asthma and Immunology Annual Meeting. “There are a variety of conditions with surfactant lung deficit, such as acute respiratory distress syndrome and cystic fibrosis, among others, but we really are going to think about asthma.”

Damage to lung surfactant can occur with refractory lung disease with inflammation in patients with bronchial asthma, DuBuske said. Therefore, he and colleagues sought to determine whether replacing the lung surfactant with inhalation treatment could improve some parameters of asthma.

The study included 29 patients with severe bronchial asthma who were assigned a 70-day course of treatment with 21 individual 25 mg inhalations of synthetic lung surfactant along with continuing inhaled corticosteroids. They were then assessed on day 70 and again at 3, 6 and 9 months. All were diagnosed according to the 2016 Global Initiative for Asthma guidelines and had asthma for 1 to 24 years.

After 21 lung surfactant inhalations, results showed statistically significant decreases in the number of patients with nocturnal attacks, profuse expectoration, cough, wheezing and shortness of breath with exertion. Nine months after stopping treatment, these benefits were retained, and the researchers also noted improvement in daytime attacks and bronchospasm under exertion. Additionally, two patients were able to discontinue inhaled corticosteroids and 21 were able to reduce their inhaled corticosteroid dose by half.

In terms of lung function, FVC increased linearly during the treatment period (P < .05) and became normal (80%) after nine inhalations (day 15). FEV₁ also increased linearly during treatment (P < .05) but did not quite reach normal levels. FEV₁:FVC ratio appeared to improve slightly but mostly remain unchanged from days 1 to 15 and was 67.4 at day 41 (P < .05), according to DuBuske. Peak expiratory flow also increased linearly (P < .01) from 57.7% to 76.2% predicted.

Pulmonary function parameters at days 250 and 340 were not significantly different than at day 70 — the conclusion of treatment — indicating that the lung surfactant inhalations may confer long-term benefit, DuBuske said.

“This 70-day course of natural/synthetic lung surfactant improved overall clinical conditions in these patients, allowed half the dose of inhaled corticosteroids and improved lung function parameters,” he said. – by Melissa Foster

Reference:

DuBuske LM. A201. Presented at: American College of Allergy, Asthma and Immunology Annual Meeting; Nov. 7-11, 2019; Houston.

Disclosure: DuBuske reports no relevant financial disclosures.