The use of triple therapy, ICS/LABA/LAMA, in the treatment of asthma: A real-life Latin-American specialized centers experience

Background: The use of triple therapy with inhaled corticosteroids (ICSs), long-acting beta-agonists (LABAs), and long-acting muscarinic antagonists (LAMAs) is increasingly common in asthma management, particularly in patients with uncontrolled disease. However, real-world data from Latin-American settings are limited. Objective: We sought to compare asthma control and exacerbation frequency among patients receiving ICS/LABA/LAMA versus ICS/LABA alone at steps 4 and 5 of the Global Initiative for Asthma guidelines in specialized centers in Mexico. Methods: A cross-sectional observational study was conducted in 3 allergy and pulmonary clinics. Adult patients with asthma receiving maintenance therapy at Global Initiative for Asthma step 4 or 5 were recruited. Demographic, clinical, and spirometric data were collected. Asthma control was assessed using the asthma control test. Comparisons were made between patients receiving ICS/LABA/LAMA and those receiving ICS/LABA only. Ordinal logistic regression was used to identify predictors of asthma control. At step 4, ICS/LABA/LAMA use was associated with better asthma control in the unadjusted analysis; however, this association was no longer statistically significant after adjustment in the ordinal logistic regression model. Conclusions: ICS/LABA/LAMA may improve asthma control at step 4 but not at step 5, possibly due to more severe disease and previous use of biologics in the latter group. These findings highlight the need for tailored therapy and better phenotyping in severe asthma.