CLINICAL CARE: RESPIRATORY
BY CHRIS ILIADES, MD
Asthma Update New guidelines and studies aim to improve asthma control In 2020, for the first time in 13 years, there was a significant change in asthma-treatment recommendations. The 2020 Focused Updates to the Asthma Guidelines included a new recommendation to replace separate inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) inhalers with a single combination device that would be used daily for both prevention and rescue therapy.1,2 This recommendation was based on multiple studies showing that single maintenance and reliever therapy (SMART) offers better asthma control for patients ages 5 and older with moderate persistent asthma that is not well controlled. Combining asthma medications into a single inhaler is more effective and easier to use.2
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The Promise of Triple Therapy The new guidelines also recommended—for the first time—using a bronchodilator called a long-acting muscarinic antagonist (LAMA) in certain situations.2 Although a LAMA is not a preferred treatment in the current guidelines, there is a growing body of research that suggests it might play a bigger role in future guidelines. That role would be as a third addition to a single inhaler that would include an ICS, LABA, and LAMA for people with moderate to severe asthma.3,4 There have been several trials of this triple therapy. Two studies in 2019, both published in the journal Lancet, have had the most influence: • The TRIMARAN trial included 1,155 adults who had at least one serious asthma exacerbation per year, despite being on a moderate-dose ICS. This was a randomized, double-blind study conducted in 16 countries. Patients
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FEBRUARY/MARCH 2022
3/13/22 9:45 PM
