Triple inhaler therapy for asthma appears to improve outcomes
Article written by Bruce Sylvester.
Researchers report that,
when compared with dual inhaler therapy for moderate to severe asthma, triple
therapy for children aged 6 to 18 years and adults is significantly associated
with fewer severe exacerbations and with modest improvements in asthma control.
The investigators also
reported no significant differences between therapies in quality of life or
They reported these findings
on May 19, 2021 in JAMA/Journal of the American Medical Association.
As background, the authors
noted that they were addressing the question of whether adding a long-acting
muscarinic antagonist (LAMA) to inhaled corticosteroids (ICS) and long-acting β2-agonists
(LABAs) produced significant differences in outcomes among patients with
moderate to severe persistent asthma.
They identified and evaluated
studies in the MEDLINE, Embase, CENTRAL, ICTRP, FDA, and EMA databases.
They extracted, pooled and
compared data on severe exacerbations, asthma control, quality of life,
mortality and adverse events.
They included 20 randomized
and controlled clinical trials using 3 LAMA types and enrolling 11,894 children
and adult subjects — mean age of 52 years and 57.7% female.
They reported high-certainty
evidence that triple therapy vs dual therapy was significantly associated with
a reduction in severe exacerbation risk, 22.7% vs 27.4%, respectively, and with
improvement in asthma control.
They reported no significant
differences in asthma-related quality of life or mortality between dual and
Triple therapy was
significantly associated with increased dry mouth and dysphonia. However,
treatment-related and serious adverse events were not significantly different
between the dual and triple therapy groups.
The authors concluded, “In
this systematic review and meta-analysis of 20 RCTs [randomized controlled
trials] including 11 894 children (aged 6 to 18 years) and adults with
uncontrolled moderate to severe asthma, triple therapy compared with dual
therapy was significantly associated with fewer severe exacerbations and modest
improvements in asthma control without significant differences in quality of
life or mortality. No significant difference was observed in treatment-related
or serious adverse events.”