Making Sense of Triple Inhaled Therapy for COPD

Guidelines for the treatment of chronic obstructive pulmonary disease (COPD) have consistently recommended long-acting inhaled bronchodilators — either long-acting muscarinic antagonists (LAMAs) or long-acting inhaled beta-agonists (LABAs) — as initial maintenance therapy. If disease control is not achieved, as manifested by inadequate lung function and disease exacerbations, guidelines recommend their combined use.1 Although there is general agreement about the role of LAMAs and LABAs in the treatment of COPD, the role for inhaled glucocorticoids in this treatment guideline has been the object of much debate because of their modest effectiveness and concerns about safety, particularly the risk of pneumonia.2 The . . .