Triple Therapy for the Management of COPD: A Review

Authors: Gaebel, Kathryn; McIvor, R. Andrew; Xie, Feng; Blackhouse, Gord; Robertson, Diana; Assasi, Nazila; Hernandez, Paul; Goeree, Ron

Source: COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 8, Number 3, May 2011 , pp. 206-243(38)

Publisher: Informa Healthcare

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Abstract:

Triple therapy for COPD consists of a long-acting anti-cholinergic bronchodilator, a long-acting beta-agonist bronchodilator, and an inhaled corticosteroid. Guidelines from the Canadian Thoracic Society advocate triple therapy for some patients with moderate-to-severe COPD. The objective of this review was to evaluate the evidence based clinical efficacy of triple therapy compared to dual bronchodilator therapy (long-acting anti-cholinergic bronchodilator ++ beta-agonist bronchodilator) or long-acting anti-cholinergic bronchodilator monotherapy for managing COPD. A systematic literature search was conducted to identify relevant clinical evaluations of triple therapy in the management of moderate to severe COPD. Databases searched included: Medline; EMBASE; CINAHL and PubMed (non-Medline records only). Of 2,314 publications, 4 articles evaluated triple therapy for the management of COPD. Hospitalization rates for COPD exacerbations, reported in 2 trials, were significantly reduced with triple therapy compared to long-acting anti-cholinergic bronchodilator monotherapy, with reported relative risks of 0.53 (95%% CI: 0.33, 0.86, p == 0.01) and 0.35 (95%% CI: 0.16--0.78, p == 0.011). Exacerbation data is inconsistent between the two trials reporting this outcome. Lung function, dyspnea and quality of life data show statistical significant changes with triple therapy compared to long-acting anti-cholinergic bronchodilator monotherapy but the changes do not reach clinical importance. Triple therapy does decrease the number of hospitalizations for severe/acute COPD exacerbations compared with long-acting anti-cholinergic bronchodilator monotherapy. There is insufficient evidence to determine if triple therapy is superior to dual bronchodilator therapy.

Keywords: Chronic Obstructive Pulmonary Disease; Inhaled bronchodilators; Inhaled corticosteroids; Systematic review; Triple therapy

Document Type: Research article

DOI: http://dx.doi.org/10.3109/15412555.2011.560131

Affiliations: 1: Department of Medicine, Dalhousie University, Halifax, Nova Scotia6

Publication date: 2011-05-01

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