Single-Inhaler Triple Therapy (SITT) for COPD: An Italian expert opinion paper on improving clinical outcomes and equity of therapeutic access

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, with significant burden in Italy. Prevalence estimates vary by data source: Health Search data indicate a prevalence of 2.7% among adults, whereas population-based analyses report higher estimates of approximately 5.6%. Triple therapy combining a long-acting muscarinic antagonist (LAMA), a long-acting beta2-agonist (LABA), and an inhaled corticosteroid (ICS) has been shown to improve lung function, reduce exacerbations, and potentially decrease mortality in moderate-to-severe COPD. Fixed-dose Single-Inhaler Triple Therapy (SITT) provides practical advantages over Multiple-Inhaler Triple Therapy (MITT), including improved treatment adherence, fewer inhaler technique errors, and comparable safety. This expert opinion review summarizes evidence from randomized controlled trials and real-world studies supporting the clinical, practical, and economic benefits of SITT. While access to SITT in Italy is influenced by regulatory frameworks, optimizing prescription practices and aligning treatment strategies with clinical evidence could enhance continuity of care and patient outcomes. The paper highlights strategies to improve COPD management, reduce treatment discontinuation, and ensure equitable access to effective therapies.