Fixed-dose triple combination of budesonide/glycopyrronium/formoterol in patients with asthma: a literature review

Asthma remains a common chronic disease, in which control is not achieved in some patients despite the use of medium doses of inhaled corticosteroids in combination with a long-acting β2-agonist (ICS/LABA). After evaluating the diagnosis, inhalation technique, adherence, and modifiable risk factors, one escalation option includes adding a long-acting muscarinic antagonist (LAMA), preferably as part of a fixed-dose triple combination. Objective. To summarize the data on the role of the budesonide/glycopyrronium/formoterol (BUD/GLY/FORM) combination in the treatment of uncontrolled asthma, with an emphasis on the results from the phase III KALOS and LOGOS trials. Material and methods. The review is based on the international GINA 2026 strategy, the Russian clinical guidelines for asthma, publications on the clinical significance of exacerbations, and randomized trials of adding LAMA to ICS/LABA. Studies of fixed-dose triple combinations (TRIMARAN, TRIGGER, IRIDIUM, CAPTAIN), as well as trials of BUD/GLY/FORM (KALOS and LOGOS) are reviewed separately. The interpretation took into account study designs, inclusion criteria, choice of comparators, and endpoints. Results. In the KALOS and LOGOS studies, treatment with BUD/GLY/FORM improved lung function and reduced the rate of severe exacerbations compared with budesonide/formoterol (pre-dose forced expiratory volume in 1 second increased by 76 mL; severe exacerbation rate ratio was 0.86) with a comparable safety profile. The inclusion of patients without a documented history of severe exacerbations in the previous year or the requirement of persistent airflow limitation was an important feature of the program. Conclusion. The findings support the use of fixed-dose triple therapy in patients with persistently uncontrolled asthma while taking ICS/LABA.