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COPD and the single inhaler question

Canadian clinicians already believe in single inhaler triple therapy. A national investigation of 219 healthcare professionals and 292 people living with COPD shows why it still isn’t being prescribed to everyone who needs it.

RESPIPLUS national investigation · October 2026 · 32 pages · PDF

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511

healthcare professionals and patients surveyed across Canada

65%

of clinicians call cost or coverage a major barrier to prescribing SITT

79%

of patients seen by a clinician or admitted to hospital for a flare-up had no change to their
inhalers

64%

of patients on multiple inhalers were never asked if they could be combined

The barrier isn't clinical doubt

Current Canadian guidelines recommend triple therapy for people with COPD at high risk of flare-ups, and in July 2026 Canada’s Drug Agency updated its national reimbursement recommendations to match. 87% of the healthcare professionals surveyed say single inhaler triple therapy (SITT) is always or
often their first-line choice for these patients.

So the question this investigation set out to answer was not whether clinicians are convinced. It was what happens between that conviction and the patient’s prescription.

The answer sits in three places: coverage rules, administrative paperwork, and the moments of care where a medication review should happen and often does not.

Seven findings from the field

Clinicians support SITT — the barrier is downstream of belief

87% say it is always or often their first-line choice for high-risk patients, and 87% believe stable MITT patients should be proactively switched, in most cases or for selected patients.

Perceived cost, coverage rules and administrative burden outweigh clinical hesitation

Cost or coverage: a major barrier for 65%. Special Authorization and Limited Use codes: 42%. Concerns about ICS side effects, insufficient evidence and low eosinophil count each ranked at 5%
or below.

Spirometry access is a real bottleneck

59% of clinicians report barriers accessing spirometry in their region; a quarter of those describe waits over six months.

The biggest barrier clinicians face is largely invisible to patients

Among patients who were given a reason for their treatment, only 3% were told it had to do with insurance coverage.

The moment after an exacerbation at hospital or emergency department discharge is a confirmed, shared gap

Only 32% of clinicians say inhaler review at discharge is always standard process, and 79% of patients seen by a clinician or admitted to hospital for a flare-up report no change afterward.

Patients are confident in their technique, but it is rarely checked

78% feel very comfortable using their inhaler correctly; 35% say no healthcare professional has ever watched them do it.

Patients are rarely the ones who start the conversation about change

76% say their doctor or specialist first raised the idea of changing treatment. Only 11% raised it themselves.

A call to action, by role

The report closes with recommendations addressed to the groups that each hold part of the solution:

Payers and formulary decision-makers

Implementing the July 2026 CDA reimbursement update provincially, and reviewing and, where inconsistent with it, removing Special Authorization and Limited Use criteria.

Hospitals and discharge planning

Building a standard medication-review step into COPD exacerbation discharge, with a ready-to-use checklist.

Professional associations and continuing education

Directing effort at the administrative pathway and practical measurement rather than at persuasion.

Prescribers

Raising single-inhaler consolidation proactively, and building brief technique checks into refill visits.

Patients and patient organizations

Asking directly whether inhalers could be combined, and pushing for written action plans.

Behind the investigation

This is a RESPIPLUS initiative. We gratefully acknowledge the involvement of representatives from the Canadian Thoracic Society, the Family Physician Airways Group of Canada, and COPD Canada. Their participation does not imply organizational endorsement of the findings or
recommendations.

Two survey instruments were fielded across Canada in the spring of 2026, in English and French, and reviewed before fielding by a Scientific and Patient Committee:

Dr. Jean Bourbeau, MD, MSc, FRCPC, FCAHS
Respirologist and Professor of Medicine, McGill University Health Centre; Past President, Canadian Thoracic Society
Dr. Alan Kaplan, MD, CCFP(EM), FCFP, CPC(HC)
Family Physician; Chairperson, Family Physician Airways Group of Canada
Dr. Mohit Bhutani, MD, FRCPC
Respirologist and Professor of Medicine, University of Alberta;
Past President, Canadian Thoracic Society; Co-Chair, CTS COPD Clinical Assembly
Michael Boivin, BSc.Phm, RPh, CDE, CTH
Clinical Pharmacist Consultant; President, CommPharm Consulting Inc.
Henry Roberts
Patient representative, Executive Committee, COPD Canada

RESPIPLUS team

Maria Sedeno, MM, BEng — Executive Director
Emily Horvat, BSc — Senior Project Director
Katrina Metz, RRT — Consultant

RESPIPLUS is a Canadian non-profit that has spent two decades building education and self-management programs in chronic respiratory disease, delivered through ChronicLungDiseases.com.

An initiative of RESPIPLUS, in collaboration with

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Frequently asked questions

What is single inhaler triple therapy?

Triple therapy combines three medication classes for people with COPD who keep having symptoms or flare-ups despite simpler treatment: an inhaled corticosteroid, a long-acting beta-agonist, and a long-acting muscarinic antagonist. Single inhaler triple therapy (SITT) delivers all three from one device. Multiple inhaler triple therapy (MITT) splits the same three classes across two or more devices.

Who was surveyed?

219 healthcare professionals and 292 people living with COPD, across Canada, in the spring of 2026. Both surveys were offered in English and French. Respiratory therapists made up 52% of the healthcare professional sample.

Is the report free?

Yes. It downloads without registration, a login or a paywall. You can leave your email if you would rather receive it in your inbox, but it is not required.

Who funded this investigation?

The investigation and this report were made possible by a sponsorship from Methapharm. The sponsor had no role in the development, content, or review of the report.

This report is for informational purposes only. It is not a clinical guideline and should not be used to influence patient treatment plans. Its content reflects the input of the members of the Scientific and Patient Committee and does not provide or supersede medical or professional advice — for any question, consult a qualified healthcare professional. Reliance on any information in this report is at your own risk. RESPIPLUS assumes no liability for its accuracy, completeness or timeliness.

This RESPIPLUS national investigation into single inhaler triple therapy in COPD, and the creation of this report, was made possible by a sponsorship from Methapharm. The sponsor did not have any role in the development, content, or review of this report.