For several years, there has been evidence of a pharmacological advantage in combining LABAs and ICSs in both asthma 3 and COPD. The evidence of a favorable pharmacological interaction between LABAs, LAMAs, and ICSs is growing. Pharmacological interaction between LABA, LAMA, and ICS

The information thought to be more significant has been selected and commented upon. We supplemented the bibliographic database searches with backward citation tracking of relevant publications. To address this topic, we have identified studies from EMBASE, MEDLINE, Scopus, The Cochrane Library, Web of Science, and Google Scholar. In this article, we critically review the literature in order to determine, if possible, the real role of triple therapy in the treatment of asthma and COPD. 2 These recommendations are supported by pivotal clinical trials that have evaluated the effects of triple therapy in both COPD and asthma and the subsequent meta-analysis. 1 In contrast, GINA plans to add tiotropium, the only LAMA approved for the treatment of asthma, to ICS/LABA when the disease is not well controlled and before escalating to treatment with biologics or low-dose oral corticosteroids.

GOLD recommends adding a LAMA to an ICS/LABA combination or an ICS to a LABA/LAMA combination, depending on the different clinical situations mainly related to the presence of dyspnoea or exacerbations, with the option to refer to blood eosinophil count. However, there is a substantial difference between the GOLD and GINA strategies. Strategy reports from both the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 1 and the Global Initiative for Asthma (GINA) 2019 2 highlight the importance of using the triple combination of inhaled corticosteroids (ICS), long-acting β 2-agonists (LABAs), and long-acting muscarinic receptor antagonists (LAMAs) in the treatment of chronic obstructive pulmonary disease (COPD) and asthma, respectively. KeywordsĪsthma, COPD, triple therapy, single-inhaler Article: However, there is a real risk that the use of single-inhaler triple therapy will expand the “one-size-fits-all” approach that has conditioned the prescriptive behavior of many doctors in the recent past, with little consideration of individual patient variability when making management decisions. Pivotal trials have shown that there is a role for triple therapy, mainly for single-inhaler triple therapy, in both COPD and asthma management. Three single-inhaler triple therapies-beclomethasone dipropionate/formoterol/glycopyrronium, fluticasone furoate/vilanterol/umeclidinium, and budesonide/glycopyrronium/formoterol - are available to treat COPD, whereas no single-inhaler triple therapy has yet been approved for use in asthma, but several trials have evaluated, or are exploring, this possibility. As there is well-documented evidence that triple therapy is effective in improving lung function and reducing the risk of exacerbation in patients with asthma and those with COPD, single-inhaler triple therapies have been developed mainly to increase adherence to treatment that often is low because of complexity introduced by the additional inhaler(s). A favorable pharmacological interaction between long-acting β 2 agonists, long-acting muscarinic receptor antagonists, and inhaled corticosteroids (ICSs) explains why triple therapy is effective both in chronic obstructive pulmonary disease (COPD) and asthma however, it has been documented that the presence of an ICS may cause the occurrence of pneumonia.

Ics laba lama combination asthma