Triple versus Dual Inhaled Therapy for Symptomatic Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Abstract

Introduction: For patients with Chronic Obstructive Pulmonary Disease (COPD) who remain symptomatic on dual bronchodilator therapy, guidelines suggest stepping up to triple therapy (LAMA/LABA/ICS). This review evaluates the efficacy of this strategy.

Methods: We searched for RCTs comparing single-inhaler triple therapy (LAMA/LABA/ICS) to dual therapy (LAMA/LABA or LABA/ICS) in COPD patients with a history of exacerbations. The primary outcome was the rate of moderate-to-severe exacerbations.

Results: The meta-analysis of six large RCTs showed that triple therapy significantly reduced the annual rate of moderate-to-severe exacerbations compared to dual therapy. Triple therapy also resulted in improved lung function (FEV1) and health-related quality of life. An increased risk of pneumonia was observed with ICS-containing arms.

Discussion: In appropriately selected symptomatic COPD patients with an exacerbation history, escalating to triple therapy provides significant clinical benefits. The risk of pneumonia must be considered in the decision-making process.

Conclusion: Single-inhaler triple therapy is superior to dual therapy in reducing exacerbations and improving lung function in symptomatic COPD patients.