CHEST Guidelines-Single-vs Multiple-Inhaler-Triple-Therapy-in-

Single-vs Multiple-Inhaler-Triple-Therapy-in-

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The document examines the effects of single-inhaler versus multiple-inhaler triple therapy (SITT vs MITT) for chronic obstructive pulmonary disease (COPD), a significant global health issue. The study by Alcázar-Navarrete et al., referenced in the CHEST journal, investigates how these treatments affect patient persistence, exacerbation rates, and healthcare costs. Utilizing a database from Spain, including 1.9 million patients, the study found higher persistence rates for those using SITT compared to MITT at both 6 and 12 months. Persistence, while different from adherence, can indicate how well patients follow prescribed medication regimens over time.<br /><br />Previous studies, like those by Ferguson et al., suggest SITT is at least as effective as MITT. SITT's convenience could contribute to better adherence, and thus improved outcomes, although the study cautions that poorer inhaler technique, potentially more common with MITT due to its complexity, was not assessed. Despite the benefits seen in persistence and potentially lower exacerbation rates with SITT, the study highlights that confounding factors, such as socioeconomic status (SES), were not adjusted for and could influence outcomes. <br /><br />Limitations include potential biases from unvalidated or incomplete data, especially concerning unmeasured factors like SES or patient inhaler technique. The study emphasizes the need for simplifying inhaler therapies to improve patient adherence and health outcomes. Acceptance and insurance coverage of SITT may present challenges as it is relatively new in certain regions. Overall, while suggesting that SITT may lead to better persistence and possibly improved health outcomes, the document acknowledges that further research is needed to fully assess its superiority over MITT.

Keywords

single-inhaler triple therapy

multiple-inhaler triple therapy

COPD

patient persistence

healthcare costs

adherence

exacerbation rates

socioeconomic status

inhaler technique

health outcomes