Poster:
Impact of single-inhaler triple therapy on COPD treatment on COPD treatment in the period from 2016-2022: A nationwide Danish cohort study1,2
Clinical practice: Why this matters
For clinicians, the results highlight how treatment simplification can directly improve patient outcomes. Use of fewer devices is associated with lower risk of critical inhaler errors, improved adherence, and contributes to fewer exacerbations — including those requiring hospitalization.1,2 Prescribing patterns indicate that GPs are adopting SITT widely as a practical choice in everyday COPD care. Moving patients from MITT to SITT represents a patient-centered strategy to optimize disease management with measurable benefits.
Authors: N. Krogh, A. Falch-Jørgensen, L. Dalsager, Y. Çolak.
Between 2016 and 2022, treatment patterns for COPD in Denmark underwent a marked transformation as the introduction of the single-inhaler triple therapy (SITT) combining ICS, LABA and LAMA in one device as opposed to multiple inhaler triple therapy (MITT). Did the introduction of the first SITT in 2017 impact treatment uptake and adherence, and if so, how?
A new Danish real-world study provides insight on how it transformed COPD care. The study followed 44,883 patients with COPD who started using triple therapy between 2016–2022 and compared outcomes for SITT users versus MITT.
Key findings:
| Prescription patterns | Within just one year, SITT accounted for more than half of all new triple therapy initiations, rapidly replacing MITT as the preferred option. Initially, specialists were the primary prescribers, with 83 % of SITT prescriptions coming from hospital-based physicians. However, this trend gradually equalized, and by 2022 general practitioners were responsible for almost half (45 %) of new SITT initiations.2 Overall, the proportion of patients receiving triple therapy remained stable (~47 %).1 |
| Previously redeemed treatment1 | Previously redeemed treatments among patients in 180 days prior to initiating SITT: * 28% from MITT * 30% from dual * 6% from mono * 36% no treatment |
| Adherence after 2 years of treatment2 | High treatment adherence, defined as >80% of days covered: * Single inhaler users: 79% * Multiple inhaler users: 49% |
| Exacerbation risk 2 | Annual exacerbation rate SITT: 1.05 MITT: 1.09 Exacerbation risk Any exacerbation: SITT users had 5% lower risk of any exacerbation compared to MITT users (RR 0.95, 95 % CI: 0.92–0.97) Severe exacerbation requiring hospitalization: SITT users had 12 % lower risk compared to MITT (RR 0.88, 95 % CI: 0.83–0.93) |
In conclusion:
Treatment with SITT compared to MITT in patients with COPD was consistently associated with higher short- and long-term adherence and a lower risk of both overall and severe exacerbations.1,2 As demonstrated by Sulku et al., it is more likely that a patient masters inhalation technique correctly with one inhaler than with two or more inhalers. Thus, critical errors are more frequent with multiple inhalers and may lead to reduced or no effect of treatment.3 Together these findings support the growing role of SITT as a cornerstone of COPD management in clinical practice.
Nicolai Krogh
Medical Advisor, Chiesi Nordic
References
- Krogh, N et al (2025). Impact of single-inhaler triple therapy on COPD treatment in the period from 2016-2022: A nationwide Danish cohort study [Abstract]. ERS congress 2025, Amsterdam, Netherlands. https://www.ersnet.org/
- Çolak, Y et al. Use of Single-Inhaler vs. Multiple-Inhaler Triple Therapy Improves Adherence and Reduces Exacerbation Risk in COPD: A Nationwide Cohort study in Denmark. Poster presented at: ERS Congress 2025; 29 Sept; Amsterdam, Netherlands.
- Sulku J, et al. Critical inhaler technique errors in Swedish patients with COPD: a cross-sectional study analysing video-recorded demonstrations. NPJ Prim Care Respir Med. 2021 Feb 9;31(1):5.
ID: 16975-29.09.2025