Potential for the extrafine combination of beclomethasone dipropionate, glycopyrronium bromide and formoterol fumarate in the treatment of severe bronchial asthma

Severe bronchial asthma (SBA) remains a challenging clinical problem associated with a significant disease burden, frequent exacerbations, and a worsened quality of life. Despite modern inhaled therapy options, including high doses of inhaled glucocorticosteroids (ICS) in combination with long-acting beta-2 agonists (LABAs), a large number of patients remain inadequately controlled. In recent years, one therapeutic advance in severe asthma has been the introduction of triple-inhaler therapy combining ICS, long-acting beta-agonists (LABAs), and long-acting muscarinic antagonists (LAMAs). An important question in the management of severe asthma is whether triple therapy can delay or eliminate the need for biological agents. A systematic search was performed in the electronic databases PubMed, Web of Science, and Medline. The findings revealed that extrafine beclomethasone – formoterol – glycopyrronium significantly improved lung function, reduced the risk of asthma worsening and the occurrence of exacerbations, and allowed patients to achieve sustained disease control without biological therapy. This was accompanied by significant improvements in symptoms, small airway function, and peripheral inflammation. Consequently, the inhaled triple combination ICS/LABA/LAMA may be considered a first-line treatment strategy for severe asthma, with the potential to enhance disease management and postpone the need for initiating biologic agents.