Conflicting evidence is currently available concerning the impact on asthma exacerbation of triple inhaled corticosteroid (ICS)/long-acting β₂-adrenoceptor agonist (LABA)/long-acting muscarinic receptor antagonist (LAMA) fixed-dose combination (FDC).

Since meta-analyses allow settling controversies of apparently inconsistent results, we performed a network meta-analysis of phase III randomised controlled trials including 9535 patients to assess the effect of ICS/LABA/LAMA combinations in uncontrolled asthma.

Triple combination therapies with an ICS administered at high dose (HD) were more effective (p<0.05) than medium-dose (MD) ICS/LABA/LAMA FDC and both MD and HD ICS/LABA FDCs against moderate to severe exacerbation (relative risk 0.61–0.80) and increasing trough forced expiratory volume in 1 s (from +33 to +114 mL). Triple combination therapies including HD ICS were superior (p<0.05) to MD ICS/LABA/LAMA FDC in preventing severe exacerbation (relative risk 0.46–0.65), but not with respect to moderate exacerbation (p>0.05). Triple combination therapies were equally effective on asthma control, with no safety concerns.

This quantitative synthesis suggests that ICS/LABA/LAMA FDCs are effective and safe in uncontrolled asthma, and that the dose of ICS in the combination represents the discriminating factor to treat patients with a history of moderate or severe exacerbation.

目前关于三联吸入皮质类固醇 (ICS)/长效 β2-肾上腺素受体激动剂 (LABA)/长效毒蕈碱受体拮抗剂 (LAMA) 固定剂量组合 (FDC) 对哮喘发作的影响存在相互矛盾的_证据。

由于荟萃分析可以解决明显不一致的结果的争议，我们对包括 9535 名患者的 III 期随机对照试验进行了网络荟萃分析，以评估 ICS/LABA/LAMA 组合对不受控制的哮喘的影响。

与中剂量 (MD) ICS/LABA/LAMA FDC 以及 MD 和 HD ICS/LABA FDC 相比，采用高剂量 (HD) 的 ICS 三联疗法对中度至重度恶化（相对风险 0.61–0.80）并在 1 秒内增加用力呼气谷量（从 +33 到 +114 mL）。包括 HD ICS 在内的三联疗法在预防严重恶化（相对风险 0.46-0.65）方面优于 MD ICS/LABA/LAMA FDC（p<0.05），但在中度恶化方面则不强（p>0.05）。三联疗法对哮喘控制同样有效，没有安全问题。

这种定量综合表明 ICS/LABA/LAMA FDCs 在不受控制的哮喘中是有效和安全的，并且组合中的 ICS 剂量代表了治疗有中度或重度恶化史的患者的区别因素。