TRIPLE THERAPY FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FROM ANALYSIS TO PRACTICE
Chronic obstructive pulmonary disease (COPD) has become one of the leading non-infectious problems of medicine over the last three decades. The presence of three groups of inhaled drugs, each of which is well studied in COPD, has empirically led to the use of triple combinations in the treatment of COPD. Data on the effectiveness and prevalence of triple therapy (TT) are still fewand sometimes contradictory, which made this literature review as relevant. The results of randomized clinical trials of combinations of fluticasone furoate/ vilanterol/umeclidinium, budesonide/formoterol fumorate/glycopyrronium bromide and beclomethasone dipropionate/formoterol fumorate/glycopyrronium bromide, as well as combinations of tiotropium bromide with budesonide/formoterol fumorate and a combination of tiotropium bromide with a fluticasone propionate/salmeterol are presented. TT, which includes two long-acting bronchodilators and an inhaled glucocorticosteroid, is widely used in actual clinical practice in different countries, despite the fact that indications for its use are limited to severe COPD with severe symptoms and frequent exacerbations. Conducted clinical studies have proved the safety of TT, but the evidence base for the effectiveness of TT remains insufficient. Obviously, this variant of therapy should be studied not only in COPD with different severity, but also among patients with different phenotypes. On the one hand, this will allow to optimize treatment, on the other hand, to save the resources of the healthcare system and patients.