For a patient whose asthma is not controlled by medium-to-high–dose inhaled corticosteroids (ICS) and a long-acting ß-agonist (LABA), current guidelines e.g., Global Initiative for Asthma recommend adding a long-acting antimuscarinic agent (LAMA). In two industry-sponsored European trials, which differed only in whether medium- or high-dose beclomethasone was used, researchers examined whether a single inhaler that contained ICS plus a LABA and a LAMA worked better than an inhaler that contained ICS/LABA.
More than 2,500 patients were randomised to beclomethasone, formoterol (a LABA), and glycopyrronium (a LAMA) in a single, ultra-fine, metred-dose inhaler (triple-therapy groups) or to beclomethasone and formoterol in a single inhaler (dual-therapy groups). After 26 weeks, mean improvement in pretreatment FEV1 (forced expiratory volume in 1 second) improved more with triple therapy than with dual therapy (by ≈60–70 mL).
Although this study only showed modest improvements in lung function and exacerbation prevention, an FDA-approved triple-therapy option in a single inhaler for asthma would be convenient. The only currently available triple inhaler in the U.S. (Trelegy Ellipta) is approved for use only in patients with chronic obstructive pulmonary disease.