Triple therapy with two long acting bronchodilatators and inhaled corticosteroid in COPD
Triple therapy with an inhaled corticosteroid, a long-acting b2- agonist, and a long-acting muscarinic antagonist should be given to patients with severe or very severe chronic obstructive pulmonary disease (COPD) and a high risk of exacerbations who do not respond to treatment with two long-acting bronchodilatators or bronchodilator plus an inhaled corticosteroid. Randomized clinical trials have shown that triple therapy reduces the risk of moderately severe to severe exacerbations and improves bronchial obstruction and quality of life of patients as compared with the other regimens of treatment. Several large scale clinical trials (TRILOGY, TRINI- TY, TRIBUTE) have established the efficacy and safety of a single inhaled corticosteroid/long-acting muscarinic antagonist/long-acting b2-agonist inhaler combining extra fine formulations of beclometasone dipropionate, formoterol fumarate, and glycopyrronium bromide in patients with severe and very severe COPD.