The effectiveness of single inhaler triple therapy in patients with bronchial asthma in real clinical practice

Abstract

Introduction. About 40% of patients with bronchial asthma on dual therapy with inhaled glucocorticosteroids and long-acting β2-agonists do not achieve asthma control.Aim. To evaluate the efficacy of triple therapy (fluticasone furoate, umeclidinium bromide, vilanterol) in a single inhaler in patients with bronchial asthma in real clinical practice.Material and methods. The study included 43 patients with bronchial asthma from municipal outpatients’ clinics in Ekaterinburg and the Sverdlovsk region. The clinical-functional and clinical-economic efficiency of therapy was evaluated for 6 months before and after the appointment of a triple combination (fluticasone furoate, umeclidinium bromide, vilanterol) in a single inhalerResults and discussion. Of the 43 patients, 39 patients were included in the analysis. During 6 months of triple therapy in a single inhaler, the  mean ACT value increased from 13  (Q1–Q3: 12–14) to 21  points (Q1–Q3: 20–22) (p <   0.001), the  proportion of patients with uncontrolled asthma decreased from 100% initially to 15.4% at 6 months of therapy (p< 0.001). By the 6th month of therapy, all patients refused to take systemic glucocorticosteroids (p = 0.003), there was an increase in FEV1 from 73.0% (Q1–Q2: 70.0–75.0) to 82% (Q1–Q2: 80.0–86.5) (p < 0.001). The number of ambulance calls (from 0.28 ± 0.46 per 1 patient at baseline) and hospitalizations (from 0.67 ± 0.84 per 1 patient at baseline) decreased to 0 (p >< 0.001) after 6 months of treatment with the  study drug. Savings in  the management of  1  patient for  6  months on a  triple therapy in  a single inhaler amounted to 10523 rubles, and the prevented economic damage for 39 patients for 6 months of therapy is 410418 rubles. Conclusion. The triple therapy in a single inhaler made it possible to improve asthma control and respiratory function, stop taking systemic glucocorticosteroids, reduce the number of hospitalizations and emergency calls, while reducing direct costs per unit of efficiency.>< 0.001). The number of ambulance calls (from 0.28 ± 0.46 per 1 patient at baseline) and hospitalizations (from 0.67 ± 0.84 per 1 patient at baseline) decreased to 0 (p< 0.001) after 6 months of treatment with the  study drug. Savings in  the management of  1  patient for  6  months on a  triple therapy in  a single inhaler amounted to 10523 rubles, and the prevented economic damage for 39 patients for 6 months of therapy is 410418 rubles.Conclusion. The triple therapy in a single inhaler made it possible to improve asthma control and respiratory function, stop taking systemic glucocorticosteroids, reduce the number of hospitalizations and emergency calls, while reducing direct costs per unit of efficiency.