Inhaled triple therapy is being recommended for patients with severe chronic obstructive pulmonary disease (COPD) as a step up therapy. Inhaled triple therapy consists of 3 ingredients;
- Inhaled corticosteroids
- Long acting muscarinic antagonists (LAMA)
- Long acting Beta agonists (LABAs)
This is considered a step up therapy for patients with frequent exacerbations. Two recent studies were conducted that strengthened the evidence to support this recommendation. The first one published in the New England Journal of Medicine, showed the inhaled triple therapy (fluticasone furoate, umeclidinium and vilanterol) for 52 weeks, decreased the rate of of moderate to severe exacerbations compared to dual therapy alone. However, the risk of pneumonia increased. The second study published in the Lancet, compared inhaled triple therapy (beclomethasone dipropionate, glycopyrronium and formoterol fumarate with dual therapy. After 1 year, triple inhaled therapy decreased the rate of moderate and severe exacerbations. Notably, triple inhaled therapy with this combination was not associated with an increased risk of pneumonia.
The findings of these 2 trials support use of inhaled triple therapy to prevent COPD exacerbations in patients with severe COPD in whom dual bronchodilator therapy fails.
In previous blog posts, we discussed two new triple therapies that were approved.
Both of these inhaled triple therapies were approved for COPD alone. Currently the treatment of choice for moderate to severe asthma patients is dual therapy (inhaled corticosteroids and a long acting Beta agonist). Medications in this class are Breo, Dulera, Symbicort, AirDuo Respiclick and Advair.
Although these inhaled triple therapy medications are not currently FDA approved for asthma, adding a LAMA to dual therapy is currently being used for asthma patients not well controlled.
It may be a matter of time before these inhaled triple therapy medications are approved for asthma. For severe asthma patients, recently several biological injectable medications were approved.
If you suffer from COPD or asthma and it is not well controlled and you are having frequent and severe exacerbations, speak to your doctor and see what medications may be best for you.