Patients are missing out

While GPs are familiar with triple therapy treatment for COPD, many are not considering the treatment for asthma patients.

Respiratory Physician at St Andrews Medical Centre, Dr Andrew Scroop, has seen low rates of GP-initiated triple therapy treatment for asthma patients. He says inconsistent messaging about treatment and constantly changing guidelines are likely causes of the slow uptake.

“For example, the dry powder capsule, Enerzair, was not promoted well and it hardly gained any traction. Most people have never heard of it, even though it is easily available,” says Dr Scroop.

“Another challenge for GPs is that the guidelines change with each update and it’s hard to keep abreast of where you should be.

“The PBS streamlined authority criteria are actually a very good synopsis of where you should be prescribing triple therapy to asthma patients. GPs should be able to access that in their prescription software.”

With new triple therapy options available for asthma, including Trelegy Ellipta 200, Dr Scroop says it is a good time for GPs to refresh their understanding of asthma treatment pathways and options.

“If a patient is still experiencing one or two exacerbations a year requiring oral steroids and they’ve been on a medium dose of ICS LABA for more than 12 months, they’re a perfect group to step up to triple therapy,” he says.

“I would also consider patients with frequent asthma symptoms, such as Ventolin use overnight or three or more times each week.”

Evidence of the merits of triple therapy for high dose ICS LABA patients is mixed. Dr Scroop says there is a subgroup who can benefit.

“They tend to be people who are less allergic and older, and who might have a smoking history or a prominent cough. To some degree, they’ll have a chronic bronchitis or COPD feel to them,” he says.

Before stepping up a patient up to triple therapy, Dr Scroop says it is important to check the patient is taking their current treatment correctly.

He points out that in trials of triple therapy for asthma, all participants improved their asthma control irrespective of whether they received trial medication or usual therapy.

“If there’s any doubt about asthma control, the first thing is to check their inhaler technique to make sure they’re doing it correctly. I check it every time I see a patient,” Dr Scroop says.

“You need to check and recheck because people develop bad habits over time. If they’re not actually using what you have already prescribed, there’s no point changing to something else.”

Dr Andrew Scroop is giving a lecture on triple therapy in the upcoming Healthed webcast on Tuesday 22nd of November. Register here to attend.