Current appraisal of single inhaler triple therapy in COPD

Brian Lipworth (Lead / Corresponding author), Rui Wen Kuo, Sunny Jabbal

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9 Citations (Scopus)
94 Downloads (Pure)

Abstract

A single inhaler containing inhaled corticosteroid (ICS)/long acting beta-agonists (LABA)/long acting muscarinic antagonists (LAMA) is a more convenient way of delivering triple therapy in patients with COPD Single triple has been shown to be superior at reducing exacerbations and improving quality of life compared to LABA/LAMA especially in patients with a prior history of frequent exacerbations and blood eosinophilia, who have ICS responsive disease. The corollary is that patients with infrequent exacerbations who are non eosinophilic may be safely de-escalated from triple to LABA/LAMA without loss of control. Pointedly there is a substantially increased risk of pneumonia associated with the triple containing fluticasone furoate but not belcometasone dipropionate. Since triple is also better than ICS/LABA at reducing exacerbations and improving lung function, symptoms and quality of life, this brings into question the rationale for using ICS/LABA anymore. Hence we propose a simplified pragmatic decision process based on symptoms prior exacerbation history and blood eosinophils to select which patients should be given single triple or LABA/LAMA. Differences in patient preference inhaler devices formulations and drugs will also determine which triple inhaler prescribers elect to use.
Original languageEnglish
Pages (from-to)3003-3009
Number of pages7
JournalInternational Journal of Chronic Obstructive Pulmonary Disease
Volume13
Issue number13
DOIs
Publication statusPublished - 28 Sep 2018

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Muscarinic Antagonists
Nebulizers and Vaporizers
Chronic Obstructive Pulmonary Disease
Adrenal Cortex Hormones
Quality of Life
Drug Compounding
Patient Preference
Eosinophilia
Therapeutics
Eosinophils
Pneumonia
History
Equipment and Supplies
Lung

Keywords

  • Chronic Obstructive Pulmonary Disease
  • Inhaled Corticosteroid
  • Long acting beta-agonist
  • Long acting muscarinic antagonist
  • Lung function
  • Exacerbation
  • lung function
  • long-acting beta-agonist
  • long-acting muscarinic antagonist
  • inhaled corticosteroid
  • COPD
  • exacerbation

Cite this

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title = "Current appraisal of single inhaler triple therapy in COPD",
abstract = "A single inhaler containing inhaled corticosteroid (ICS)/long acting beta-agonists (LABA)/long acting muscarinic antagonists (LAMA) is a more convenient way of delivering triple therapy in patients with COPD Single triple has been shown to be superior at reducing exacerbations and improving quality of life compared to LABA/LAMA especially in patients with a prior history of frequent exacerbations and blood eosinophilia, who have ICS responsive disease. The corollary is that patients with infrequent exacerbations who are non eosinophilic may be safely de-escalated from triple to LABA/LAMA without loss of control. Pointedly there is a substantially increased risk of pneumonia associated with the triple containing fluticasone furoate but not belcometasone dipropionate. Since triple is also better than ICS/LABA at reducing exacerbations and improving lung function, symptoms and quality of life, this brings into question the rationale for using ICS/LABA anymore. Hence we propose a simplified pragmatic decision process based on symptoms prior exacerbation history and blood eosinophils to select which patients should be given single triple or LABA/LAMA. Differences in patient preference inhaler devices formulations and drugs will also determine which triple inhaler prescribers elect to use.",
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