Current appraisal of single inhaler triple therapy in COPD

TY - JOUR

T1 - Current appraisal of single inhaler triple therapy in COPD

AU - Lipworth, Brian

AU - Kuo, Rui Wen

AU - Jabbal, Sunny

PY - 2018/9/28

Y1 - 2018/9/28

N2 - 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.

AB - 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.

KW - Chronic Obstructive Pulmonary Disease

KW - Inhaled Corticosteroid

KW - Long acting beta-agonist

KW - Long acting muscarinic antagonist

KW - Lung function

KW - Exacerbation

KW - lung function

KW - long-acting beta-agonist

KW - long-acting muscarinic antagonist

KW - inhaled corticosteroid

KW - COPD

KW - exacerbation

U2 - 10.2147/COPD.S177333

DO - 10.2147/COPD.S177333

M3 - Article

C2 - 30319248

SN - 1176-9106

VL - 13

SP - 3003

EP - 3009

JO - International Journal of Chronic Obstructive Pulmonary Disease

JF - International Journal of Chronic Obstructive Pulmonary Disease

IS - 13

ER -