Serrano Carolina Cisneros, Moragón Eva Martínez, Padilla-Galo Alicia, Aracil Cleofé Fernández, Alonso Andrea Trisán, Chica Gerardo Pérez, Bastida Ana Pueyo, Falcón Auxiliadora Romero, Carretero-Gracia José Ángel, Soto-Campos José Gregorio
Hospital Universitario de La Princesa, Madrid, Spain.
Hospital Universitario Doctor Peset, Valencia, Spain.
Open Respir Arch. 2025 May 13;7(3):100442. doi: 10.1016/j.opresp.2025.100442. eCollection 2025 Jul-Sep.
Despite existing guidelines, many patients with asthma do not achieve adequate control of their disease. This is largely due to low adherence to inhaled therapy. Single-inhaler administration may improve this and other aspects of asthma therapy, such as cost-effectiveness. The aim of this study is to gather the opinions of a panel of experts on single-inhaler triple therapy (SITT) for the treatment of asthma in adult patients.
A recommendation task force reviewed the available evidence and formulated 45 statements divided into 5 sections: efficacy, cost-effectiveness, therapeutic adherence, safety, and patient satisfaction. A validation task force of 71 experts evaluated these recommendations using the 2-round Delphi technique. Panellists rated their agreement with each statement on a 9-point scale.
Consensus was achieved in 42 of the 45 statements. Panellists broadly agreed that SITT improves lung function, reduces exacerbations, is cost-effective, and promotes therapeutic adherence. The safety of TT was considered favourable, even in patients with cardiovascular comorbidities. The panellists also agreed on the importance of evaluating patient satisfaction with the inhaler. However, no consensus was reached regarding the suitability of TT as a first-line treatment, nor on whether TT is more beneficial than up-dosing ICS in patients with a low inflammatory profile currently receiving dual therapy. Additionally, panellists did not agree on whether sick leave due to respiratory causes was associated with greater adherence to TT.
The consensus indicates that SITT is considered an effective, safe option for the treatment of asthma that improves therapeutic adherence and patient satisfaction. Further real-world studies are needed to evaluate its implementation in different clinical contexts.
尽管有现有指南，但许多哮喘患者的疾病仍未得到充分控制。这在很大程度上是由于吸入疗法的依从性较低。单吸入器给药可能会改善哮喘治疗的这一方面以及其他方面，例如成本效益。本研究的目的是收集一组专家对单吸入器三联疗法（SITT）治疗成年哮喘患者的意见。
一个推荐工作组审查了现有证据，并制定了45条陈述，分为5个部分：疗效、成本效益、治疗依从性、安全性和患者满意度。一个由71名专家组成的验证工作组使用两轮德尔菲技术对这些建议进行了评估。小组成员以9分制对他们对每条陈述的同意程度进行评分。
45条陈述中有42条达成了共识。小组成员普遍认为SITT可改善肺功能、减少病情加重、具有成本效益并促进治疗依从性。即使在有心血管合并症的患者中，三联疗法的安全性也被认为是良好的。小组成员还一致认为评估患者对吸入器满意度的重要性。然而，关于三联疗法作为一线治疗的适用性，以及对于目前接受双联疗法且炎症水平较低的患者，三联疗法是否比增加吸入性糖皮质激素（ICS）剂量更有益，尚未达成共识。此外，小组成员对于因呼吸道原因导致的病假是否与三联疗法的更高依从性相关也未达成一致。
共识表明，SITT被认为是一种有效、安全的哮喘治疗选择，可提高治疗依从性和患者满意度。需要进一步的真实世界研究来评估其在不同临床环境中的应用情况。
