Does Triple Therapy Benefit Patients with Chronic Obstructive Pulmonary Disease?

Stepwise treatment for patients with chronic obstructive pulmonary disease (COPD), as recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), consists of either a long-acting antimuscarinic antagonist (LAMA) or long-acting β-agonist (LABA) as the initial agent, followed by dual LAMA/LABA therapy, and, lastly, triple therapy with a LAMA, a LABA, and an inhaled corticosteroid (ICS; NEJM JW Gen Med Jun 15 2017 and Am J Respir Crit Care Med 2017; 195:557). Triple therapy is used widely, but its effectiveness compared with dual therapy has not been studied.

In an industry-funded, international multicenter trial, 1532 symptomatic COPD patients with forced expiratory volume in 1 second (FEV₁) <50% of predicted and exacerba…