Double or Triple Therapy in Chronic Obstructive Pulmonary Disease

Abstract

Although the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy recommends triple therapy involving long-acting muscarinic antagonists (LAMAs), long-acting β2-agonists (LABAs) and inhaled corticosteroids (ICS) only for further advanced patients, particularly for those at a high risk for exacerbation (GOLD D), triple therapy is widely prescribed in real-life management of chronic obstructive pulmonary disease (COPD), even in patients with mild or moderate COPD severity, likely because physicians prefer to prescribe a full treatment to ensure the best care to their patients. While the available clinical evidence on triple therapy has greatly increased in recent years, there is still no solid evidence to indicate whether and when addition of an ICS to the LABA/LAMA combination provides additional clinical value. Therefore, a strong recommendation can still not be generated but the results of four recent pivotal triple therapy studies support the possibility that this treatment option should be considered also for GOLD B patients. (BRN Rev. 2018;4(4):287-303) Corresponding author: Mario Cazzola, mario.cazzola@uniroma2.it