{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:34:41Z","timestamp":1787027681855,"version":"build-2736575974"},"reference-count":31,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["ARM"],"abstract":"<jats:p>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 \u00b1 12.30% to 75.10 \u00b1 18.94%, p &lt; 0.001) and FEF25\u201375 (from 47.80 \u00b1 19.23% to 75.10 \u00b1 36.06%, p &lt; 0.001). Additionally, during the same period, we recorded significant reductions in residual volume (from 130.10 \u00b1 28.20% to 92.55 \u00b1 21.18%, p &lt; 0.001) and total airway resistance (Rtot) (from 164.60 \u00b1 83.21% to 140.70 \u00b1 83.25%, p &lt; 0.05). The mean asthma control test (ACT) score increased by 5.6 points (p &lt; 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 \u00b1 17.67% to 40.29 \u00b1 16.65%, p &lt; 0.01). Correlation analysis indicated significant associations between diaphragmatic function and some lung function parameters (FEV1, FEF25\u201375, 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.<\/jats:p>","DOI":"10.3390\/arm93050040","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T11:06:02Z","timestamp":1759316762000},"page":"40","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Real-World Efficacy of Beclomethasone Dipropionate\/Formoterol Fumarate\/Glycopyrronium on Diaphragmatic Workload Assessed by Ultrasound and Lung Function in Patients with Uncontrolled Asthma"],"prefix":"10.3390","volume":"93","author":[{"given":"Antonio","family":"Maiorano","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Magna Graecia University, Viale Europa\u2014Localit\u00e0 Germaneto, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Ferrante Bannera","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Magna Graecia University, Viale Europa\u2014Localit\u00e0 Germaneto, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Lupia","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Magna Graecia University, Viale Europa\u2014Localit\u00e0 Germaneto, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Pastore","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Magna Graecia University, Viale Europa\u2014Localit\u00e0 Germaneto, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8314-715X","authenticated-orcid":false,"given":"Emanuela","family":"Chiarella","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa\u2014Localit\u00e0 Germaneto, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna Lucia","family":"Piazzetta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa\u2014Localit\u00e0 Germaneto, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1874-1686","authenticated-orcid":false,"given":"Angelantonio","family":"Maglio","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8265-3037","authenticated-orcid":false,"given":"Alessandro","family":"Vatrella","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9288-8913","authenticated-orcid":false,"given":"Girolamo","family":"Pelaia","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Magna Graecia University, Viale Europa\u2014Localit\u00e0 Germaneto, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4236-7367","authenticated-orcid":false,"given":"Corrado","family":"Pelaia","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa\u2014Localit\u00e0 Germaneto, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/S0140-6736(17)33311-1","article-title":"Asthma","volume":"391","author":"Papi","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1038\/nm.2678","article-title":"Asthma phenotypes: The evolution from clinical to molecular approaches","volume":"18","author":"Wenzel","year":"2012","journal-title":"Nat. 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