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October 2019

Three-in-one inhaler can improve lung function and reduce asthma attacks



Patients with severe asthma that is not controlled with standard treatment could benefit from using a single inhaler combining three, instead of two therapies, according to two phase 3 randomised controlled trials with over 2,500 patients across 17 countries, presented at the European Respiratory Society (ERS) Conference 2019.

Using multiple inhalers leaves patients trying to use devices of different design, with different instructions, and with different dosing regimens (such as the number of inhalations per day). This can reduce patients’ ability to use them regularly as prescribed, so a single inhaler that combines therapies could help ensure effective treatment delivery and improve treatment adherence.

A two-in-one inhaler combines an inhaled corticosteroid (ICS) and long-acting bronchodilator such as a long-acting beta2 agonist (LABA), but some patients continue to experience asthma attacks and symptoms, and need the addition of a third drug, such as a muscarinic antagonist. The two new studies, TRIMARAN and TRIGGER, investigated the effects of adding it to a two-in-one combination inhaler, which also contained ICS and LABA.

The studies demonstrated improvements in lung function and reductions in the number of moderate to severe asthma attacks, compared with standard combined therapy with ICS and a LABA.

‘The effects of triple therapy might seem moderate when you look at the numbers involved, but even incremental improvements can be valuable when there are few treatment options left available,’ said lead author Professor Christian Virchow from the Rostock University Medical Centre in Germany.


Virchow JC, et al. The Lancet 2019. ePub 30 September 2019. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32215-9/fulltext