Extrafine triple therapy in patients with asthma and persistent airflow limitation.

The addition of a long-acting muscarinic antagonist (LAMA) is a recognised treatment option for patients whose asthma is uncontrolled with an inhaled corticosteroid (ICS) plus long-acting β2-agonist (LABA) combination [1]. The data supporting this recommendation were provided from studies in which the LAMA tiotropium was added to ICS/LABA combinations using separate inhalers [2, 3]. The use of separate inhalers, most often of different design, with contrasting instructions for use and dosing regimens is not only inconvenient for patients and healthcare providers who provide instruction on correct inhaler use, but can negatively impact treatment adherence and persistence – and therefore outcomes [4–7]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Singh reports personal fees from Chiesi, during the conduct of the study; personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from Cipla, personal fees from Genentech, personal fees from GlaxoSmithKline, personal fees from Glenmark, personal fees from Menarini, personal fees from Mundipharma, personal fees from Novartis, personal fees from Peptinnovate, personal fees from Pfizer, personal fees from Pulmatrix, personal fees from Theravance, personal fees from Verona, outside the submitted work. Conflict of interest: Dr. Vele reports and I am an employee of Chiesi, the sponsor of the two studies. Conflict of interest: Dr. Kots reports and I am an employee of Chiesi, the sponsor of the two studies. Conflict of interest: Dr. Georges reports other from Chiesi USA, Inc., during the conduct of the study; other from Chiesi USA, Inc., outside the submitted work. Conflict of interest: Dr. Papi reports grants, personal fees, non-financial support and other from Chiesi, grants, personal fees, non-financial support and other from Astrazeneca, grants, personal fees, non-financial support and other from GlaxoSmithKline, grants, personal fees, non-financial support and other from Boehringer Ingelheim, personal fees and non-financial support from Menarini, personal fees and non-financial support from Novartis, personal fees and non-financial support from Zambon, grants, personal fees, non-financial support and other from Mundipharma, grants, personal fees, non-financial support and other from TEVA, personal fees and non-financial support from Sanofi, outside the submitted work. Conflict of interest: Dr. Canonica reports personal fees from A. Menarini, personal fees from Alk-Abello, personal fees from Allergy Therapeutics, personal fees from AstraZeneca-Medimmune, personal fees from Boehringer Ingelheim, personal fees from Chiesi Farmaceutici, personal fees from Genentech, personal fees from Guidotti-Malesci, personal fees from GlaxoSmithKline, personal fees from Hal Allergy, personal fees from Merck Sharp & Dome, personal fees from Mundipharma, personal fees from Novartis, personal fees from Orion, personal fees from Sanofi-Aventis, personal fees from Sanofi Genzyme/Regeneron, personal fees from Stallergenes-Greer, personal fees from Uriach Pharma, personal fees from Teva, personal fees from Valeas, personal fees from ViforPharma, outside the submitted work. Conflict of interest: Dr. Virchow reports personal fees from Chiesi , during the conduct of the study; and In the past J. Christian Virchow has ectured and received honoraria fromUstraZeneca, Avontec, Bayer, Bencard, Bionorica, Boehringer-Ingelheim, Chiesi, Essex/Schering-Plough, GSK, Janssen-Cilag, Leti, MEDA, Merck, MSD, Mundipharma, Novartis, Nycomed/Altana, Pfizer, Revotar, Sanofi/Regeneron, Sandoz-Hexal, Stallergens, TEVA, UCB/Schwarz-Pharma, Zydus/Cadila and possibly othersUnd participated in advisory boards and received honoraria fromUvontec, Boehringer-Ingelheim, Chiesi, Essex/Schering-Plough, GSK, Janssen-Cilag, MEDA, MSD, Mundipharma, Novartis, Paul-Ehrlich Institut, Regeneron, Revotar, Roche, Sanofi-Aventis, Sanofi/Regeneron, Sandoz-Hexal, TEVA, UCB/Schwarz-Pharma and possibly othersUnd received funding for research from Ýeutsche Forschungsgesellschaft, Land Mecklenburg-Vorpommern, GSK, MSDUnd has advised the Bemeinsame Bundesausschuss (GBA).