ICSs should be continued when the history suggests that asthma overlaps with COPD. In this situation, the blood eosinophil count could aid decision making. If patients exacerbate despite adhering to triple therapy, an individualized approach should be considered if the inhaled corticosteroid (ICS) confers benefit or causes side effects. During each review, HCPs should consider stepping treatment up or down. Appropriate non-pharmacological management is essential for all patients and should be considered before stepping up treatment. The panel suggested three criteria, any one of which identifies a high-risk patient where escalation to triple therapy from monotherapy or double combination treatment is appropriate: 1) at least two exacerbations treated with oral corticosteroids, antibiotics, or both in the previous year 2) at least one severe exacerbation that required hospital admission in the previous year 3) one exacerbation a year on a repeated basis for 2 consecutive years. The survey confirmed the need to clarify the place of SITT in COPD management.

A survey of UK health care professionals (HCPs) identified issues around, and attitudes toward, SITT, which informed a multidisciplinary expert panel’s discussions. This paper offers practical, patient-focused advice to optimize placement of SITT in the management of COPD. While single-inhaler triple therapy (SITT) devices were not available when the Global Initiative for Chronic Obstructive Lung Disease strategy and National Institute for Health and Care Excellence guidelines were developed, two devices are now available in the UK.

Trelegy ics laba lama medicine