Why Triple Therapies for Asthma Aren't for Me (...Yet?)
Last updated: February 2023
I was recently at a virtual event focused around people with severe asthma and treatment options.
Triple therapies for asthma
Over the last several years, more options in the category called "triple therapies" are becoming available to treat asthma, as well as COPD. These contain an inhaled steroid, a long-acting anti-cholinergic, a type of bronchodilator, and a classic long-acting bronchodilator.
Momentarily, I always get excited about new medications coming to market, especially when they are just not remixes of old things in a new device, new combination, or so on. And then I remember: hold on, I have never even tried a triple therapy, and nope, for me, that is not a good option right now, anyways.
A puzzle of combinations
I spent years of trial and error working to get my asthma under control. We went through a lot of different combinations of things at various doses: Symbicort, Symbicort at off-label high doses, Advair, back to Symbicort, Symbicort and Pulmicort and Atrovent, Symbicort and Qvar and Atrovent, Zenhale and Qvar and Atrovent, Zenhale and Qvar and Spiriva...oh and sprinkled in here and there with each combo some Singulair for a bit. In the end, we figured out the final combo of a combination inhaler (Zenhale), an add-on inhaled steroid (Qvar specifically due to its ability to get into the smaller airways better) and an anticholinergic (short-acting Atrovent, then long-acting Spiriva) is my best bet.
Writing this all down feels like one of those puzzles with the grid where you have to determine whether Joe, Ted, or Mary brought the cake, chips, or drinks to the party and what color shirt they were wearing. That is kind of how it felt as we tried to figure out the best combination to treat my severe asthma!
However, just because I take a combination of three things that are found in these triple therapies, does not, in my mind, mean I would be better off on a triple therapy!
Why do this...and why not do that?
Every once in a while the pharmacy computer remembers I am on two inhaled steroids--one in the combo inhaler and one standalone--and freaks out. The reason for this is we have determined I need a bit more steroid to keep my lungs happy, but I do not necessarily need the correlating amount of bronchodilator--see above about "off-label high doses" of Symbicort.
Plus, I know I do well on this combination of things. I have the flexibility to tweak as I need to -- (Do I need less Spiriva because things have been going well? Can I bump my Qvar up or down when I feel a slow-burn flare looming that is likely inflammation related?) This flexibility has absolutely kept me out of doctors' offices and emergency rooms--and off prednisone more times than I can count, as well! It is possible a triple therapy could get me down to two controller inhalers rather than three... but really, that is not much of an improvement in my eyes.
Personalized medicine: A future for asthma?
I cannot really see the likelihood where compounding pharmacies do asthma treatment, but it certainly could happen one day. The cost, however, and burden of disease on the system for personalized treatment for asthma may make this entirely impractical on a broader level.
But, it would be really cool if one day I could get inhalers customized to my specific maintenance needs so I could do just one puff, once or twice a day, even if I did have to add on a regular-type Qvar or Zenhale for an extra puff in a flare on occasion!
And while the current triple-therapy options are not for me, I hope one day perhaps a smart device is available where I could dial up specific doses of each individual component, based on my needs that day. Hey, I can dream, right?
Has the availability of triple-therapies changed your asthma management at all?
How often do you experience a shortage in your asthma medication?