Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Triple Inhaled Therapy in COPD Patients

One fifth of primary care patients with chronic obstructive pulmonary disease (COPD) are prescribed with triple inhaled (TI) therapy over 4.5 years, a new study found. The study examined the incidence and determinants of the TI therapy in a cohort of patient with COPD, prescribed for the first time with inhaled treatments, and followed-up between January 2002 - December 2014. The primary outcome was the first incident prescription of a TI therapy. Researchers found:

  • Of 17,589 patients (mean age 71.1 years, 37.4% female), 21% were prescribed with a TI therapy during follow-up.
  • Older age, cigarette smoking, COPD severity and heart failure were significantly associated with an escalation to the TI therapy.
  • Female sex and some comorbidities were negatively associated with the outcome.
  • Patients initially treated with long-acting muscarinic antagonists (LAMA) and long-acting beta agonists/inhaled corticosteroids (LABA/ICS) were more likely to escalate to the TI therapy vs those on LABA.


Vetrano, DL. Triple inhaled therapy in COPD patients: Determinants of prescription in primary care. [Published online ahead of print May 29, 2019]. Respir Med. doi: 10.1016/j.rmed.2019.05.022.