Real-world users of triple therapy for asthma in the US

Am J Manag Care. 2024 Feb;30(2):74-81. doi: 10.37765/ajmc.2024.89494.


Objectives: For patients with asthma who remain symptomatic on a medium-dose inhaled corticosteroid/long-acting β2 agonist, addition of a long-acting muscarinic antagonist as a supplementary controller is a recommended option. However, real-world data on the characteristics and treatment patterns of these patients are limited. This study described the demographics and clinical characteristics of new users of single- or multiple-inhaler triple therapy and treatment patterns preceding triple-therapy initiation.

Study design: This retrospective cohort study used medical and pharmacy claims data from the IQVIA PharMetrics Plus database.

Methods: The study population comprised adults with asthma with or without chronic obstructive pulmonary disease (COPD) initiating triple therapy with single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; 100/62.5/25 μg) or multiple-inhaler triple therapy (MITT) between September 18, 2017, and September 30, 2019. Demographics, clinical characteristics, and treatment patterns in the 12 months preceding triple-therapy initiation were described (baseline period).

Results: A total of 12,395 patients were included. Among FF/UMEC/VI initiators with asthma (n = 1301), the mean age was 49.0 years and 59.3% were women. During the baseline period, 81.5% of patients used controller therapy, 94.7% used rescue medications, and 42.0% reported at least 1 asthma-related exacerbation; the annual mean exacerbation rate was 0.96. Similar trends were observed among patients with asthma initiating MITT and patients with comorbid asthma-COPD initiating FF/UMEC/VI or MITT.

Conclusion: In real-world practice, triple therapy is often utilized following other asthma controller medication use. High disease burden, as evidenced by substantial use of rescue medications and continued asthma-related exacerbations, suggests that patients may not have achieved adequate asthma control prior to triple-therapy initiation.

MeSH terms

  • Administration, Inhalation
  • Adult
  • Asthma* / drug therapy
  • Bronchodilator Agents / therapeutic use
  • Drug Combinations
  • Female
  • Fluticasone / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Muscarinic Antagonists / therapeutic use
  • Pulmonary Disease, Chronic Obstructive* / drug therapy
  • Retrospective Studies


  • Bronchodilator Agents
  • Fluticasone
  • Muscarinic Antagonists
  • Drug Combinations