Key takeaways
- Triple therapy for asthma consists of a corticosteroid, a long-acting beta agonist, and an anticholinergic, which work together to reduce airway inflammation and relax the airway muscles.
- Healthcare professionals may recommend triple therapy when standard asthma treatment (a short-acting inhaler alone or with a daily corticosteroid) doesn’t control your symptoms or prevent flare-ups.
- Common side effects include throat irritation, dry mouth, elevated heart rate, and constipation. Your doctor will discuss the risks and benefits with you.
“Triple therapy” stands for three different medication classes that are being used in combination to help control asthma or other lung diseases:
- inhaled corticosteroids
- inhaled long-acting beta agonists
- inhaled anticholinergics
There are many different medications within each class, so there are a variety of options for the combination of triple therapy.
Having controlled asthma means living with few to no symptoms on a day-to-day basis and being able to perform your usual daily activities without having breathing difficulties. It also means not having regular flare-ups (exacerbations) of your asthma. Some people with asthma require more medication to try to achieve this goal.
Triple therapy involves a stepwise approach to try to gain control of symptoms. This typically involves first adding an inhaled corticosteroid. If that medication doesn’t control your symptoms, we would add a long-acting beta agonist medication and then, finally, an anticholinergic.
The three different medications each play a role in reducing asthma symptoms.
The inhaled corticosteroid (the cornerstone of asthma treatment) decreases airway inflammation, which is the precursor to asthma symptoms. The long-acting beta agonist and the anticholinergic both cause relaxation and opening of the smooth airway muscles.
The combination of all three medications helps improve symptoms of asthma.
Standard asthma treatment typically consists of one of the following two regimens:
- using a short-acting inhaled beta agonist (such as Albuterol) intermittently
- using a daily inhaled corticosteroid as a controller inhaler and also having the short-acting inhaled beta agonist to use intermittently as needed
If either regimen does not successfully control your asthma, there is a step-up approach to adding more medication, up to triple therapy.
Of course, there are always potential side effects to any medication. The prescribing pracitioner will discuss the side effects with you and weigh the pros and cons in order to minimize risk and maximize benefit.
Common side effects of the medications in triple therapy can include:
- throat irritation
- dry mouth
- voice hoarseness
- occasional thrush
- shakiness
- elevated heart rate
- constipation
This typically happens when a person’s asthma remains uncontrolled when they are using the combination of the inhaled corticosteroid and either the long-acting beta agonist or the anticholinergic. Triple therapy would include all three of these medication classes.
Thomas Johnson is a physician assistant who specializes in pulmonology and sleep medicine. He has been a full-time practitioner since 2004. He treats many diseases, including asthma, obstructive sleep apnea, and narcolepsy. He is part of a large group practice in northwestern Pennsylvania.