This systematic review and meta-analysis investigated the effectiveness of triple therapy combinations for treating uncontrolled asthma in adults, with a particular focus on comparing a single inhaler containing beclometasone, formoterol, and glycopyrronium (BDP/FOR/GLY) against other triple therapy options.
The study addresses an important healthcare challenge, as asthma affects 1-18% of the global population, with over 260 million people suffering from poorly controlled asthma as of 2019. When patients’ asthma remains uncontrolled with standard dual therapy (inhaled corticosteroids and long-acting β2-agonists), guidelines recommend adding a third medication.
The researchers analyzed data from multiple clinical trials, separating patients into two groups based on whether they were previously on medium-dose (MD) or high-dose (HD) therapy. This distinction was important because increasing medication doses can lead to more side effects. Key findings showed that among single-inhaler triple therapies, the MD BDP/FOR/GLY significantly reduced the risk of severe asthma attacks compared to other combinations, particularly showing a 35% reduction compared to fluticasone/umeclidinium/vilanterol.
The high-dose version of BDP/FOR/GLY also showed promising trends in reducing both severe and moderate-to-severe exacerbations compared to other triple therapy combinations. The researchers noted that using a single inhaler for all three medications could potentially improve treatment adherence and consistency compared to using multiple inhalers.
An important aspect of the study was its focus on the extra-fine formulation of BDP/FOR/GLY, which may allow better distribution of medication in both large and small airways. This could be particularly beneficial since patients with small airway dysfunction tend to have a higher risk of asthma attacks and poorer asthma control.
While the study had some limitations, including the lack of direct head-to-head trials between different triple therapies, it provides valuable evidence supporting the use of single-inhaler triple therapy, particularly BDP/FOR/GLY, in patients whose asthma remains uncontrolled on standard treatments.
