Time was, every medication for asthma, as well as COPD, was contained by itself in either a pill or an inhaler. As more useful products came onto the market pulmonary physicians began to use various combinations to help their patients. Indeed, research showed that using more than one bronchodilator in patients with COPD had greater benefit that just one product alone. In addition to bronchodilators, inhaled corticosteroids were found to be beneficial as well, in both asthma and COPD. The need for combination therapy at first was difficult since patients needed to use more than one inhaler, often several times a day. Development of long acting products helped reduce the need for three or four doses of medication per day. However, patients were still stuck with the need to use several inhalers daily. Eventually, inhalers that combined two, and now three, medications were developed. It was even shown that using combination inhalers had more benefit to patients than using the individual products separately.

Most of our patients use combination products. Initially, dual combination products were the treatment of choice for many airway conditions, and often a great deal of thought was given as to which dual inhaler therapy was most appropriate for the patient and the disease. Enter the triple inhaler, which contains two bronchodilators and a corticosteroid. Recently, this type of inhaler has been shown to be superior in some ways to dual therapy in the treatment of asthma. Improvements will continue and, hopefully, costs will too.