Clinical characteristics, treatment patterns and adherence in patients with asthma on multiple inhaler triple therapy: a review of findings

Introduction: The value of treating asthma with the triple regimen of inhaled corticosteroid (ICS), long-acting beta(2)-agonist (LABA), and long-acting muscarinic antagonist (LAMA) delivered using multiple inhalers (MITT), or a single inhaler (SITT) is supported by a growing body of evidence, although research is still limited regarding the use of MITT.Areas covered: Clinical characteristics, treatment patterns, disease burden, and persistence/adherence associated with MITT use in asthma. The MEDLINE database was searched to identify references from inception until October 2022.Expert opinion: The use of MITT is not very frequent in asthma patients, although it improves lung function and reduces the incidence of severe exacerbations. This may be due to existing concerns about using different devices on adherence and persistence to treatment, with a negative influence on outcomes, and to the fear that the patient will discontinue ICS/LABA but not LAMA. Nevertheless, although the current trend favors the SITT approach, some physicians may be induced to prescribe MITT over SITT because it allows the titration of individual components of triple therapy to be increased or decreased. Therefore, there is an evident need for pragmatic real-life studies to document when to prefer SITT and when MITT should be used.

Automated summary

The use of MITT in asthma patients is not very common, but it has been shown to improve lung function and reduce severe exacerbations. However, concerns about device adherence and persistence, as well as the fear of discontinuing ICS/LABA but not LAMA, may contribute to the limited use of MITT. While the current trend favors the SITT approach, some physicians may choose to prescribe MITT in order to titrate the individual components of triple therapy. Further real-life studies are needed to determine when SITT should be preferred over MITT.