Open and Closed Triple Inhaler Therapy in Patients with Uncontrolled Asthma

Abstract

Long-acting muscarinic antagonists (LAMAs) are a class of inhalers that has recently been included as add-on therapy in the GINA guidelines, either in a single inhaler device with inhaled corticosteroids plus long-acting β2-agonists (ICS + LABA) (closed triple inhaler therapy) or in a separate one (open triple inhaler therapy). This review summarizes the existing evidence on the addition of LAMAs in patients with persistently uncontrolled asthma despite ICS + LABA treatment based on clinical efficacy in the reduction of asthma symptoms and exacerbations, the improvement in lung function, and its safety profile.

Comprehensive Observational Study in a Large Cohort of Asthma Patients after Adding LAMA to ICS/LABA

“…However, in cases where asthma is not well controlled, adding a long-acting muscarinic antagonist (LAMA), like tiotropium or glycopyrronium, to the LABA/ICS therapy, as a single or multiple inhaler triple therapy (MITT), is recommended [1,20,21]. A recent review on uncontrolled asthma patients treated with medium or high doses of ICS + LABA showed that LAMA as an add-on therapy reduced asthma symptoms (assessed by diverse questionnaires), exacerbations, and increased lung function (measured using forced expiratory volume in the first second [FEV 1 ], peak expiratory flow and impulse oscillometry parameters, and multiple pulmonary function tests) [22]. LAMA block acetylcholine receptors on airway smooth muscle cells, glands, and nerves, easing muscle contraction and mucus secretion [23].…”