Daytime and nighttime asthma symptoms were experienced by 51.5% and 44.9% of the patients, respectively. ![]() 13 A Japanese internet survey reported that based on the GINA criteria, 49.8% and 15.1% of the patients had partly controlled and uncontrolled asthma, respectively. 12 A global cross-sectional study in 2016 demonstrated that among 8111 patients, 18.0% and 38.5% had partly controlled and uncontrolled asthma, respectively. 11 A 2009 US survey demonstrated that although 71% of the patients reported “completely controlled” or “well controlled” by themselves, the percentage of patients with asthma who made urgent care visits twice and emergency visits once yearly was 67% and 60%, respectively. 14 In 2021, the Middle East and North Africa survey using the GINA criteria reported that the percentage of patients with partly controlled and uncontrolled asthma was 29.1% and 41.5%, respectively. Patients with uncontrolled or severe asthma have been a social challenge worldwide 11–13 and in Japan. However, the strategies may be permitted as a first-line treatment in patients with asthma and chronic pulmonary obstructive disease (COPD) overlap and asthma with airflow obstructions. 1 Therefore, first-line triple and dual therapies may not be used in patients with asthma. ![]() 1 The GINA reports also recommend that ICS/LABA dual therapy be selected in patients with uncontrolled asthma using low-dose ICS monotherapy. 2–6 However, triple therapy is recommended as a second-line treatment for patients with uncontrolled asthma using ICS/LABA dual therapy. 1 A triple therapy (inhaled corticosteroid /long-acting beta-2 agonist /long-acting muscarinic antagonist ) is effective for managing moderate-to-severe asthma. The Global Initiative for Asthma (GINA) report recommends a stepwise strategy of pharmacological treatments for asthma.
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