![]() 1, 11 A recent study revealed that ~50% of patients with COPD were escalating to triple therapy within 3 years of diagnosis. 1, 10 Meanwhile, inhaled triple therapy was reserved for patients with persistent symptoms and repeated exacerbations while undergoing dual bronchodilator (LABA/LAMA) or ICS/LABA combination therapy. 1, 8, 9 Likewise, the combination of ICS and LABA was considered to be a reasonable initial management strategy for subjects with a history of asthma or hospitalization for exacerbation of COPD, at least one exacerbations of COPD, and an elevated blood eosinophil counts (≥100 cells/μL) based on GOLD 2020. ![]() Long-acting bronchodilator combinations (LAMA/LABA) have been identified as the initial drugs of choice for patients with more severe dyspnea, airflow obstruction, and hyperinflation. 3–7 Triple drug combinations can be administered using a single inhalation device alternatively, patients may use one of two sets of devices that deliver ICS/LABA and LAMA or LABA/LAMA and ICS. 2 Several pivotal studies have reported that triple inhalation therapy can reduce the risk of exacerbations and limit symptoms, as well as improve lung function and quality of life over that observed in response to dual bronchodilator and ICS/LABA combination therapy. The use of triple therapy that includes an inhaled corticosteroid (ICS), a long-acting muscarinic antagonist (LAMA), and a long-acting β 2 agonist (LABA) had been suggested as a treatment escalation strategy. According to the 2020 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report, 1 pharmacological treatment for chronic pulmonary obstructive disease (COPD) should focus on a stepwise approach, with the goal of controlling symptoms and reducing exacerbations.
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