Appropriate Use of Single Inhaled Triple Therapy in Uncontrolled Asthma: A Multinational Modified Delphi Consensus

Area of Science:

• Pulmonology
• Clinical Medicine
• Respiratory Medicine

Background:

• Uncontrolled asthma significantly impacts lung function, exacerbation frequency, quality of life, and healthcare costs.
• Standard treatment with inhaled corticosteroids and long-acting beta-agonists (ICS/LABA) is insufficient for many patients.
• Current additional therapeutic strategies for uncontrolled asthma are inconsistently utilized.

Purpose of the Study:

• To understand expert clinicians' perceptions of uncontrolled asthma treatment strategies.
• To evaluate approaches beyond ICS/LABA therapy, focusing on single-inhaler triple therapy and other add-on options.
• To gather expert consensus on managing patients with suboptimal asthma control.

Main Methods:

• A modified Delphi consensus study involving 27 international respiratory experts.
• Two rounds of online surveys with a 59-statement questionnaire, followed by a virtual panel meeting.
• Consensus was defined as 75% agreement on a 9-point scale.

Main Results:

• Consensus was reached on 39/52 statements in the first survey and 3/13 in the second.
• Most experts (93%) agreed that adding a long-acting muscarinic antagonist (LAMA) to medium-high dose ICS/LABA is a valid option for uncontrolled asthma.
• No consensus was achieved on the use of azithromycin, leukotriene modifiers, or biologics for this patient group.

Conclusions:

• International respiratory experts reached consensus on adding LAMA to ICS/LABA for patients with uncontrolled asthma.
• The findings largely align with current asthma management guidelines.
• Divergent expert opinions on certain add-on therapies underscore the need for evidence-informed treatment decisions in asthma care.