Dual vs. Triple Therapy in Asthma: Are We Ready to Move Beyond ICS-LABA?

Triple therapy for asthma containing long-acting beta-agonist (LABA), long-acting muscarinic antagonist (LAMA), and inhaled corticosteroid (ICS) is a newer option for asthma management, especially when all three components are combined in a single inhaler (SITT: single-inhaler triple therapy), which promotes better adherence than multiple inhalers. There are questions as to its efficacy beyond the ICS/LABA combination, and evidence certainly shows that it will improve lung function, decrease exacerbations, and potentially help with symptoms. Global Initiative for Asthma (GINA) suggests these are Step 5 therapies, as they add on to medium-dose ICS/LABA. Fortunately, these compounds are quite safe and well tolerated. GINA recommendations for Step 5 will be reviewed, including particularly the place for LAMA addition as add-on therapy to ICS/LABA, and novel potential clinical applications will be reviewed.