COPD Therapy: Escalation Benefit or De-escalation Harm?

Inhaler therapy for patients with COPD is guided by the severity of their illness, symptoms, frequency of exacerbations, and eosinophil counts. Patients at high risk based on frequency of exacerbations receive dual or triple inhaler therapy. Previous large trials, including IMPACT and ETHOS, were interpreted as favoring triple therapy. However, patients who had been using inhaled corticosteroids (ICS) had to discontinue them upon joining these trials, and neither study examined whether stopping ICS might be harmful in that subgroup. Researchers have now addressed this issue in a reanalysis of data from IMPACT and ETHOS.