Comparison of indacaterol with tiotropium or once-daily dual long-acting bronchodilator therapy with roflumilast for severe COPD

Background:Bronchodilators are central to the symptomatic management of patients with COPD . The aim of this study was to assess the effect of triple therapy(dual long-acting inhaled bronchodilators with roflumilast) comparison with dual long-acting bronchodilator therapy on exacerbation rate of patients with severe COPD. Methods:Twenty four patients with severe COPD received treatment with triple therapy including,Indacaterol at dose 300 mcg,Tiotropium 18 mcg,and Roflumilast 500 mcg;Twenty two patients with similar clinical condition received treatment with dual therapy including ,Indacaterol and Tiotropium at the same doses.Efficacy was assessed at 1,3,6,and 12 months. Results:Compared with dual long -acting inhaled bronchodilator therapy triple showed statistically significant reductions of chronic cough and chronic phlegm.In patients with dual treatment were more likely chronic cough (OR,2.2;p<0.05), and chronic phlegm (OR ,1.8;p<0.05).Roflumilast added on dual long-acting inhaled bronchodilator treatment significantly reduced the rate of exacerbations of COPD(OR,2.1;p<0.05). Conclusions: Dual long-acting inhaled bronchodilators with roflumilast has better effects than dual long-acting inhaled bronchodilator treatment.This evidence from our study suggest that patients with severe COPD treated with triple therapy have better clinical outcomes than those treated with dual therapy. Roflumilast added on dual long-acting bronchodilator therapy significantly reduced the exacerbation rate of severe disease .