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The clinical place of triple therapy FDC inhalers in the management of severe asthma is becoming more established.

Maintenance treatment for asthma not adequately controlled with a maintenance combination of ICS + LABAĪ Product labelling and product information displayed as the delivered doseī Product labelling and product information displayed as the metered doseĬ must have experienced at least one severe exacerbation, which has required the documented use of systemic corticosteroids in the previous 12 months while receiving optimised asthma therapy, despite documented formal assessment of and adherence to a correct inhaler technique Maintenance treatment for asthma not adequately controlled with a maintenance combination of ICS + LABA for patients who experienced one or more asthma exacerbations in the previous year Table 1: Triple therapy FDC inhalers 7-11 Severe asthma is defined by symptoms and/or exacerbations remaining uncontrolled despite addressing all potential contributing factors.

inappropriate or incorrect use of medicines.

1 Difficult-to-treat asthma is defined as asthma that remains uncontrolled despite high-dose ICS (more than 800 micrograms budesonide per day or equivalent) + LABA. Severe asthma is a subgroup of difficult-to-treat asthma.

serious flare-ups (eg, hospital admission, intensive care unit admission, or mechanical ventilation in the previous year).

frequent severe flare-ups (eg, more than one flare-up requiring treatment with oral corticosteroids in the previous year).

requires the above treatments to prevent it from becoming uncontrolled.Īsthma is uncontrolled if any of the following are identified: 1.

remains uncontrolled despite high-dose ICS + LABA (with a correct inhaler technique and good adherence) or maintenance oral corticosteroids, or.

Severe asthma is defined as asthma that: 1

Triple therapy FDC inhalers may improve adherence by reducing the number of inhaler devices required for maintenance treatment, with fewer instructions and similar dosing regimens. In asthma, there is evidence of significant noncompliance and non-adherence to medicines.

It updated the clinical criteria for indacaterol with glycopyrronium and mometasone (Enerzair Breezhaler), and amended the listing to Authority Required (Streamlined). The clinical criteria for tiotropium was also updated, but its restriction type remains unchanged. (Enerzair Breezhaler) and tiotropium (Spiriva Respimat). Prescribers should be aware of flow-on changes to the PBS listings of indacaterol with glycopyrronium and mometasone.It is the second triple therapy FDC inhaler to be listed on the PBS for this indication. On 1 April 2022, fluticasone with umeclidinium and vilanterol (Trelegy Ellipta) was listed on the PBS for severe asthma.Previously, only tiotropium was available as an add-on treatment. Treatment options for severe asthma on the PBS that don’t require specialist referral have expanded over the past year with the listings of triple therapy FDC (fixed-dosed combination) inhalers.