Is Asthma Triple Therapy Effective in Patients With High Baseline SABA Use?

woman using asthma inhaler
woman using asthma inhaler
Is asthma triple therapy with umeclidinium plus fluticasone furoate/vilanterol effective for patients with uncontrolled asthma who overuse SABA as rescue therapy?

The following article is a part of conference coverage from CHEST 2021, being held virtually from October 17 to October 20, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from CHEST 2021.


In patients with uncontrolled asthma, adding umeclidinium (UMEC) to fluticasone furoate/vilanterol (FF/VI) may improve treatment outcomes. Moreover, this improvement is independent of the patient’s usage level of short-acting β2-agonist (SABA) at baseline. These were among the findings of the Phase 3A CAPTAIN trial ( Identifier: NCT02924688) presented at the CHEST 2021 Annual Meeting, held virtually October 17 to 20.

The CAPTAIN trial is a double-blind, 24- to 52-week parallel-group study conducted in 2436 randomized adults who have uncontrolled asthma, despite use of inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) therapy. Although CAPTAIN trial findings reported thus far have indicated that adding UMEC to FF/VI resulted in an improvement in lung function and symptom control in the patient cohort as a whole, the question remained as to how treatment might affect patients with high baseline SABA use. This is an important question because patients with uncontrolled asthma may overuse rescue inhaled therapy, such as SABA.

The research presented at CHEST 2021 reported on the effect of low vs high baseline SABA use on treatment outcomes in CAPTAIN. Investigators found numerical improvements in trough forced expiratory volume in 1 second (FEV1) in both SABA subgroups (<2/≥2 puffs per day) with FF/UMEC/VI 100/62.5/25mcg vs FF/VI 100/25mcg, 122 mL and 88 mL, respectively. Treatment with FF/UMEC/VI 200/62.5/25mcg vs FF/VI 200/25mcg also led to improvements of 56 mL and 208 mL in the 2 subgroups, respectively.

In addition, Asthma Control Questionnaire (ACQ)-7 responses favoring FF/UMEC/VI vs FF/VI were consistently observed in both subgroups. Although treatment with FF/UMEC/VI 100/62.5/25mcg was associated with numerical reductions in the rate of moderate/severe exacerbations vs FF/VI 100/25mcg in both subgroups, adding UMEC to FF/VI 200/25mcg was associated with a numerical reduction only in the subgroup of patients using 2 or more puffs per day.

The authors concluded, “Adding UMEC to FF/VI was associated with numerical improvements in treatment outcomes in both baseline SABA use subgroups, with the exception that addition of UMEC to FF/VI 200/25mcg did not lead to a reduction in moderate/severe exacerbation rate in patients with lower SABA use at baseline.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Busse W, Abbott C, Chang S, Casale T, Zarankaite A, Caceres DM. CAPTAIN: effects of baseline SABA use on response to triple therapy in patients with inadequately controlled asthma on ICS/LABA. Presented at: CHEST 2021; October 17-20, 2021; Orlando, FL/Virtual. Abstract A2357-A2358.