Expert Consensus on Single-Inhaler Triple Therapy for the Treatment of Asthma in Adult Patients

Despite existing guidelines, many patients with asthma do not achieve adequate control of their disease. This is largely due to low adherence to inhaled therapy. Single-inhaler administration may improve this and other aspects of asthma therapy, such as cost-effectiveness. The aim of this study is to gather the opinions of a panel of experts on single-inhaler triple therapy (SITT) for the treatment of asthma in adult patients.

A recommendation task force reviewed the available evidence and formulated 45 statements divided into 5 sections: efficacy, cost-effectiveness, therapeutic adherence, safety, and patient satisfaction. A validation task force of 71 experts evaluated these recommendations using the 2-round Delphi technique. Panellists rated their agreement with each statement on a 9-point scale.

Consensus was achieved in 42 of the 45 statements. Panellists broadly agreed that SITT improves lung function, reduces exacerbations, is cost-effective, and promotes therapeutic adherence. The safety of TT was considered favourable, even in patients with cardiovascular comorbidities. The panellists also agreed on the importance of evaluating patient satisfaction with the inhaler. However, no consensus was reached regarding the suitability of TT as a first-line treatment, nor on whether TT is more beneficial than up-dosing ICS in patients with a low inflammatory profile currently receiving dual therapy. Additionally, panellists did not agree on whether sick leave due to respiratory causes was associated with greater adherence to TT.

The consensus indicates that SITT is considered an effective, safe option for the treatment of asthma that improves therapeutic adherence and patient satisfaction. Further real-world studies are needed to evaluate its implementation in different clinical contexts.