Abstract Rationale Triple inhaled therapy is recommended for patients with COPD at high exacerbation risk. Whether single-inhaler triple therapy (SITT) compared with multiple-inhaler triple therapy (MITT) improves adherence and reduces exacerbations at scale in real-world clinical practice remains unknown. Methods We identified all patients with COPD who initiated triple therapy with SITT or MITT between 2016 and 2022 in a Danish nationwide cohort. Adherence was assessed using proportion of days covered at 6-24 months. We analysed moderate and severe exacerbations during the following year using negative binomial regression and Fine-Gray competing-risk model. Models were adjusted for sociodemographic and clinical characteristics, including lung function, symptoms, adherence, and exacerbation history. Results Among 89,140 COPD patients, 44,883 initiated triple inhaled therapy (14,665 SITT and 30,218 MITT). Mean adherence 6 months before initiating SITT or MITT was similar in the two groups (83% vs 81%). After treatment initiation, adherence was higher with SITT (93% vs 78% at 6 months; 87% vs 65% at 12 months; 79% vs 49% at 24 months). Patients switching from MITT to SITT improved adherence by 22 percent points (from 71% to 93%). Annual exacerbation rate was lower with SITT than MITT:1.05 vs 1.09 (adjusted RR 0.95, 95%CI:0.92-0.97) for any exacerbation, and 0.24 vs 0.27 (RR 0.88, 95%CI:0.83-0.93) for severe exacerbations. SITT was also associated with a lower risk of first any and severe exacerbation in a competing-risk analysis with death as a competing event (adjusted sHRs 0.90, 95%CI:0.86-0.94 and 0.89, 95%CI:0.83-0.95 for any and severe exacerbations, respectively). Conclusions SITT was associated with markedly higher long-term adherence and lower risks of both overall and severe exacerbations compared with MITT. These findings support treatment simplification as a clinically relevant strategy to improve COPD management. Reference: Çolak Y, Dalsager L, Falch-Jørgensen AC, Krogh N. Association of Single- vs Multiple-Inhaler Triple Therapy with Adherence and Exacerbation Risk in COPD: A Nationwide Cohort Study in Denmark. Manuscript submitted. This abstract is funded by: Chiesi Pharma AB
Krogh et al. (2026) studied this question.