Triple inhaled therapy in asthma: Beliefs, behaviours and doubts

D Bagnasco, Respiratory Diseases and Allergy Department, IRCCS Polyclinic Hospital San Martino, Genoa, Italy; Department of Internal Medicine (DiMI), University of Genoa, Italy. Electronic address: dott.diegobagnasco@gmail.com.
I Ansotegui, Department of Allergy & Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain.
I Baiardini, Respiratory Diseases and Allergy Department, IRCCS Polyclinic Hospital San Martino, Genoa, Italy; Department of Internal Medicine (DiMI), University of Genoa, Italy.
A Benfante, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
J A. Bernstein, University of Cincinnati, Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Cincinnati, OH, USA.
A Bikov, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Faculty of Medical and Human Sciences, Manchester, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
B Bondi, Respiratory Diseases and Allergy Department, IRCCS Polyclinic Hospital San Martino, Genoa, Italy; Department of Internal Medicine (DiMI), University of Genoa, Italy.
L P. Boulet, Department of Medicine, Laval University, Quebec, QC, Canada.
C Panaitescu, Center of Immuno-Physiology and Biotechnologies, Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; OncoGen Center, Pius Brinzeu County Clinical Emergency Hospital, Timisoara, Romania.
G W. Canonica, Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
H Chong-Neto, Serviço de Alergia e Imunologia, Complexo Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil.
L Dubuske, Department of Medicine, The George Washington University Hospital, Washington DC, USA.
R El-Owaidy, Pediatric Allergy, Immunology, and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
M Ferraris, Respiratory Diseases and Allergy Department, IRCCS Polyclinic Hospital San Martino, Genoa, Italy; Department of Internal Medicine (DiMI), University of Genoa, Italy. Electronic address: s4200374@studenti.unige.it.
M Filipovic, Institute for Lung Diseases and Tuberculosis, Niš, Serbia.
F J. Gonzalez-Barcala, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Galicia, Spain; Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; Department of Respiratory Medicine, University Hospital of Santiago de Compostela (CHUS), Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela, Spain.
G Guidos Fogelbach, Department of Structural Biochemistry, SEPI/ENMH, I.P.N, México city, Mexico.
J C. Ivancevich, Department of Allergy and Immunology, Clínica Santa Isabel, Buenos Aires, Argentina.
E Jusufovic, Medical Faculty, University of Tuzla, Tuzla, Bosnia and Herzegovina.
K Kowal, Department of Allergology and Internal Medicine, and Department of Experimental Allergology and Immunology, Medical University of Bialystok, Bialystok, Poland.
F Lantieri, Biostatistics Unit, Health Science Department, University of Genoa, Via Pastore 1, 16132, Genoa, Italy.
B Mahboub, Rashid Hospital, Dubai, United Arab Emirates; Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
S Mihaicuta, Victor Babes Infectious Diseases and Pulmonology Clinical Hospital Timisoara, 300310, Timisoara, Romania; Centre for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041, Timisoara, Romania.
M Mincarini, Respiratory Diseases and Allergy Department, IRCCS Polyclinic Hospital San Martino, Genoa, Italy; Department of Internal Medicine (DiMI), University of Genoa, Italy.
D Nedeva, Clinic of Asthma and Allergology, UMBAL Alexandrovska, Medical University Sofia, Sofia, Bulgaria.
P Novakova, Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria.
S Novakova, Allergy Unit, Internal Consulting Department, University Hospital "St. George", Plovdiv, Bulgaria.
C Nunes, Centro de ImmunoAlergologia de Algarve, Porto, Portugal.
F R. Ricchiuto, Respiratory Diseases and Allergy Department, IRCCS Polyclinic Hospital San Martino, Genoa, Italy; Department of Internal Medicine (DiMI), University of Genoa, Italy.
P Santus, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Section of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
N Scichilone, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
P Steiropoulos, Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.

Document Type

Journal Article

Publication Date

12-1-2024

Journal

Pulmonary pharmacology & therapeutics

Volume

87

DOI

10.1016/j.pupt.2024.102333

Abstract

Long-acting muscarinic antagonists (LAMA) in association with inhaled corticosteroids (ICS) plus long-acting beta-2 agonists (LABA) are recommended by the GINA report as further option in step 4 and first choice in step 5 treatment. Despite consistent evidence of its efficacy and safety, inhaled triple therapy (ITT) is still not largely used in patients with asthma. With the aim to explore belief and behaviours of asthma specialists, an ad hoc survey has been developed by a panel of Interasma Scientific Network (INESnet) experts and subsequently defined by two Delphi rounds among an international group of physicians. The questionnaire has been distributed through Interasma social media between June and September 2023. Besides a descriptive analysis, to assess the responses gathered from the questionnaire, Spearman's non-parametric statistical method was employed. Totally, three hundred fourteen questionnaires were completed. Clinicians' attitudes and behaviours toward timing and methodologies adopted in prescribing ITT, were analysed. 35.7 % specialists consider ITT as a relevant therapeutic option, 61.8 % that is second option after reaching high dose of ICS-LABA and 89.2 % agreed that optimization of inhaled therapy should be attempted before the use of biological drugs. Persistent flow limitation and high reversibility are considered predictive factors of response. Specialists consider ITT a resource in asthma management. Although its efficacy in decreasing exacerbation rate and improving lung function were well known, the survey revealed persistent uncertainties among clinicians in positioning it highlighting the need for further measures to effectively integrate research findings into day-to-day clinical practice.

Department

Medicine

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