Triple Combination Inhalers in Chronic Obstructive Pulmonary Disease and Asthma

This is the authors' abstract. We don't add key points for this paper.

A favorable pharmacological interaction between long-acting β 2 agonists, long-acting muscarinic receptor antagonists, and inhaled corticosteroids (ICSs) explains why triple therapy is effective both in chronic obstructive pulmonary disease (COPD) and asthma; however, it has been documented that the presence of an ICS may cause the occurrence of pneumonia.As there is well-documented evidence that triple therapy is effective in improving lung function and reducing the risk of exacerbation in patients with asthma and those with COPD, single-inhaler triple therapies have been developed mainly to increase adherence to treatment that often is low because of complexity introduced by the additional inhaler(s).Three single-inhaler triple therapies-beclomethasone dipropionate/formoterol/glycopyrronium, fluticasone furoate/ vilanterol/umeclidinium, and budesonide/glycopyrronium/formoterol-are available to treat COPD, whereas no single-inhaler triple therapy has yet been approved for use in asthma, but several trials have evaluated, or are exploring, this possibility.Pivotal trials have shown that there is a role for triple therapy, mainly for single-inhaler triple therapy, in both COPD and asthma management.However, there is a real risk that the use of single-inhaler triple therapy will expand the "one-size-fits-all" approach that has conditioned the prescriptive behavior of many doctors in the recent past, with little consideration of individual patient variability when making management decisions.