Clinical Question

What are the effectiveness and safety of dual therapies with varying doses of an inhaled corticosteroid (ICS) and a long-acting beta₂ agonist (LABA) compared with triple therapies containing an ICS/LABA with varying steroid doses plus a long-acting muscarinic antagonist (LAMA) in adults and adolescents (12 years and older) with uncontrolled asthma?

Evidence-Based Answer

Compared with medium-dose dual inhaler therapy (ICS/LABA), triple inhaler therapy (ICS/LABA/LAMA) reduces steroid-requiring asthma exacerbations in adults with asthma, but not asthma-related hospitalizations.¹ (Strength of Recommendation [SOR]: A, consistent, good-quality patient-oriented evidence.)

High-dose triple therapy, but not medium-dose triple therapy, may be better tolerated than medium-dose dual therapy due to overall decreased adverse events. There is little to no difference in serious adverse events between dual and triple therapy.¹ (SOR: A, consistent, good-quality patient-oriented evidence.)

Practice Pointers

Asthma is a chronic inflammatory disease of the lungs that affects people of all ages and is characterized by reversible airway obstruction. Approximately 24.9 million people in the United States have asthma, which resulted in 94,560 hospitalizations and 986,453 million emergency department visits in 2020.² According to the Global Initiative for Asthma, the long-term goals of asthma management are to reduce severe exacerbation risk and control symptoms without causing adverse events.³ Effective management of asthma includes an algorithm for adjusting treatment for individual needs based on severity.