Monotherapy or Combination Therapy: Which Approach Improves Adherence in Patients With Asthma?


asthmaThis study by Marceau and colleagues reviewed the treatment adherence as well as the effectiveness of combination therapy among adults with asthma. The study notes that the current international, Canadian, and US asthma treatment guidelines, including the Global Initiative for Asthma, call for severity-based management of asthma, employing both symptoms and pulmonary function testing.

The National Asthma Education and Prevention Program guidelines call for the addition of long-acting beta agonists (LABAs) to inhaled corticosteroids (ICSs) when asthma is not well controlled using ICSs alone. The authors noted that both LABAs and ICSs have a complementary effect, addressing both bronchoconstriction and underlying airway inflammation. Both LABAs and ICSs may be given either concurrently (ie, with 2 separate inhalers) or in combination (ie, both medications in the same inhaler).

The study sought to compare the adherence and effectiveness of LABAs and ICSs administered either concurrently or in combination. The results demonstrated that those patients using the medications in combination were 17% less likely to stop their medication and were also 17% less likely to have a moderate to severe asthma exacerbation. The authors concluded that combination therapy might be preferred to concurrent therapy for patients with asthma with low adherence to controller therapy.


Studies have shown that patients are more likely to comply with medication regimens that are simpler and easier to take. Other studies have also shown that ICSs and LABAs in a single inhaler may be superior in reducing asthma exacerbations compared with the 2 inhalers taken separately.[1] Compliance with long-term asthma controllers is already known to be poor, and strategies that will improve compliance will ultimately improve outcomes. The authors also suggested that patients with asthma should not take LABAs without concomitant ICSs. Use of the combination inhaler helps to ensure that both medications are taken.


  1. Ringdal N, Chuchalin A, Chovan L, Tudoric N, Maggi E, Whitehead PJ. Evaluation of different inhaled combination therapies (EDICT): a randomized, double-blind comparison of Seretide (50/250 microg BD Diskus vs Formoterol (12 microg BD) and budesonide (800 microg BD) given concurrently (both via Turbuhaler) in patients with moderate to severe asthma. Respir Med. 2002;96:851-861.
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