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Can a single-Inhaler triple therapy be used to treat COPD?
What is triple therapy for COPD?
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This article reviews the current evidence and recommendations for triple therapy (ICS/LABA/LAMA) in COPD, and discusses the potential use or non-use of triple therapy in real-life situations. It also highlights the need for more research on the effects of triple therapy on lung function decline, exacerbations and symptoms.
- Lowie E.G.W. Vanfleteren, Anders Ullman, Anita Nordenson, Anders Andersson, Kristina Andelid, Leonar...
- 2019
- Overview
- What is triple therapy?
- What is dual therapy?
- Does triple therapy work better than dual therapy?
- Who is a candidate?
- What are the side effects?
- The takeaway
- GeneratedCaptionsTabForHeroSec
Triple therapy for COPD combines three inhaled medications to help you breathe easier. This can include medications to reduce swelling, widen the airway, and relax the muscles in your airway.
To treat COPD, you may need to take a combination of several different medications. Some of these drugs relax your airways. Others bring down swelling in your lungs. The goal of taking more than one drug together is to help you breathe easier.
One way to deliver COPD drugs is through an inhaler. When you breathe into this L-shaped device, it delivers the medication straight into your lungs.
You can take each drug you need through separate inhalers. Or, you can take two or three drugs in a single inhaled dose.
Triple therapy combines three inhaled COPD drugs:
•a corticosteroid to bring down swelling in your airways
•a long-acting beta-agonist to relax the muscles around your airway
•an anticholinergic drug to widen the large airways
In the past, you’d take triple therapy in two separate inhalers. One inhaler contained an inhaled corticosteroid and a long-acting beta-agonist. The other contained an anticholinergic.
In 2017, the FDA approved Trelegy Ellipta, the first triple therapy in one inhaler. It combines:
Dual therapy for COPD combines two drugs into one inhaler. This treatment has been around since 2013.
Some dual therapies combine an anticholinergic drug with a long-acting beta-agonist:
•Anoro Ellipta (umeclidinium and vilanterol)
•Duaklir (aclidinium bromide and formoterol fumarate)
Another combines a long-acting beta-agonist with a corticosteroid:
•Breo Ellipta (fluticasone furoate and vilanterol)
Triple therapy seems to reduce the number of flares and improve quality of life in people with COPD better than dual therapy. But it may increase your risk of side effects.
Studies show that people who are on triple therapy have fewer COPD flares than those who are on dual therapy. They’re also less likely to be hospitalized for attacks of COPD symptoms.
An analysis of 21 studies found that using triple therapy reduced the number of moderate-to-severe COPD flares, improved lung function, and led to a better quality of life compared to dual therapy. One downside was that people on triple therapy were more likely to get pneumonia.
Triple therapy in a single inhaler doesn’t work better than the same treatment given in three separate inhalers, research suggests. Convenience is the main advantage of taking the three drugs together. Easier dosing may help people stick with their treatment regimen and not miss doses.
Trelegy Ellipta is approved for people with COPD, including those with chronic bronchitis and emphysema. Your doctor may prescribe this drug if you’ve been taking dual therapy, but your symptoms haven’t improved enough. Trelegy Ellipta is not meant for people with asthma.
Dual therapies like Anoro Ellipta and Duaklir are approved for the maintenance treatment of COPD. Breo Ellipta is also approved to treat asthma in adults.
The most common side effects of triple therapy include:
•headache
•back pain
•a change in your sense of taste
•diarrhea
•cough
Your doctor might suggest that you go on triple therapy if the dual therapy inhaler you’ve been on hasn’t controlled your COPD symptoms well enough. Switching to triple therapy may work better at helping you avoid symptom flares.
Before you switch to a new treatment, ask your doctor what side effects it could cause. Find out if you’re at increased risk of these problems because of your health history or other medications you take. Ask how to manage any side effects you experience.
Triple therapy is a combination of three inhaled drugs that can help you breathe easier and prevent COPD flares. Learn how it works, who can benefit, and what side effects to watch out for.
Jan 14, 2022 · Growing clinical evidence suggesting that triple therapy with an inhaled corticosteroid (ICS), a long-acting β 2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) is effective has made it an attractive combination in COPD, but there is evidence that real-world prescribing of triple therapy does not always reflect recommendations ...
Jan 30, 2023 · The Informing the Pathway of COPD Treatment (IMPACT) trial compared single-inhaler triple therapy (umeclidinium, vilanterol and fluticasone furoate) with its two dual inhalers, a LABA-ICS (vilanterol and fluticasone furoate) and a LAMA-LABA (umeclidinium and vilanterol) over 1 year [2].
- Samy Suissa
- ERJ Open Res. 2023 Jan; 9(1): 00615-2022.
- 10.1183/23120541.00615-2022
- 2023/01
Nov 6, 2019 · The availability of the so-called inhaled triple therapy, that is, the combination of an inhaled long-acting ß 2 agonist (LABA), an inhaled long-acting muscarinic antagonist (LAMA) and an inhaled corticosteroid (ICS) in a single inhalation device, for the treatment of chronic obstructive pulmonary disease (COPD) has been a recent therapeutic nov...
- Jose Luis Lopez-Campos, Jose Luis Lopez-Campos, Laura Carrasco-Hernandez, Laura Carrasco-Hernandez, ...
- 10.1177/1753466619885522
- 2019
- Jan-Dec 2019
Nov 6, 2018 · The Global Initiative for Obstructive Lung Disease (GOLD) management strategy recommend triple therapy with inhaled corticosteroids, LABA, and LAMA for GOLD group D patients who develop further exacerbations after receiving initial dual treatment of LABA and LAMA. 3 4 Triple therapy using multiple inhalers has been shown to improve forced expira...
Aug 10, 2021 · Triple therapy combines three inhaled drugs to help control COPD symptoms and prevent exacerbations. Learn when it is recommended, how it compares with dual therapy, and what are the potential risks and benefits.
