SITT Up and Take Notice

Article provided by the Sir Charles Gairdner Hospital Respiratory Team.

For people with asthma and COPD, the world of inhalers seems to get increasingly complicated. Adding another medicine may mean learning a new inhaler technique, and usually means having to spend more money at the pharmacy. However, things have been changing recently with more manufacturers bringing out single inhaler triple therapies (SITT).

We asked Clinical Nurse Consultant Brooke Kyle and Asthma Educator Sara Coleman from Sir Charles Gairdner Hospital talk about this positive change.

What is SITT?

Single inhaler triple therapy (SITT) means one inhaler that contains three different drug types. The classes of medicine are:

  • an inhaled corticosteroid (ICS) to help reduce inflammation
  • a long-acting muscarinic antagonist (LAMA) which helps open the airways
  • a long-acting beta2 agonist (LABA) which is also to help open the airways

Most people with asthma or COPD take at least one of these. The most common combination inhalers at the moment have ICS and LABA (e.g. Symbicort, Seretide, Breo, Fostair). People on three medicines usually have two different inhalers.

Why is SITT beneficial?

  • Very large research studies involving many thousands of patients show better disease control for people on SITT, when compared to either ICS+LABA or LABA+LAMA
  • Buying one product rather than two is a cheaper way to get the same medicines
  • Taking medicines in one rather than two inhalers means it is more likely people will remember to take all the prescribed doses every day
  • Many people with more than one inhaler have a mixture of device types which require different techniques, e.g. both a spray and a dry powder inhaler. People in this situation get less benefit than those with device consistency

What SITT products are available?

Currently there are four different triple therapy inhalers:

Trelegy and Enerzair which are dry powder inhalers (DPIs)

Trimbow and Breztri which are pressurised metered dose inhalers (pMDIs)

Is SITT for everyone?

Importantly, most people don’t need to be on three medicines for their asthma or COPD. Taking something you don’t need just puts you at risk of side effects.

Some products are available for COPD and some for asthma. At the moment many people can’t switch to SITT without having to change their inhaler device type.

Currently, Trelegy and Trimbow are the only ones available on the PBS. Breztri is not yet available on the PBS and Enerzair is the only SITT on the PBS for asthma. In early 2022, it is highly likely that all the medicines mentioned will be PBS-listed, and some will be reimbursed for both asthma and COPD.

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