![]() ![]() Inhaled corticosteroid long-acting beta(2)-agonist long-acting muscarinic antagonist observational study triple therapy.Ĭopyright © 2019 American College of Chest Physicians. 1,8,9 Likewise, the combination of ICS and LABA was considered to be a reasonable initial management strategy for subjects with a history of asthma or. However, with the possible exception of patients with significant eosinophilia or frequent exacerbators, a LAMA-LABA combination without ICS may be preferable because it is associated with fewer severe cases of pneumonia. Long-acting bronchodilator combinations (LAMA/LABA) have been identified as the initial drugs of choice for patients with more severe dyspnea, airflow obstruction, and hyperinflation. In a real-world setting of COPD treatment, the triple combination of LAMA, LABA, and ICS inhalers is generally as effective as combining LAMA and LABA inhalers in preventing COPD exacerbations. The incidence of severe pneumonia requiring hospitalization was increased with LAMA-LABA-ICS initiation (HR, 1.46 95% CI, 1.03-2.06). For patients with two or more prior exacerbations, it was 0.83 (95% CI, 0.70-0.98). For patients with blood eosinophil counts > 6%, the HR was 0.66 (95% CI, 0.46-0.94). The adjusted hazard ratio (HR) of a COPD exacerbation associated with LAMA-LABA-ICS initiation compared with LAMA-LABA initiation was 0.97 (95% CI, 0.87-1.08). The cohort included 6,921 initiators of LAMA-LABA-ICS matched to 1,932 initiators of LAMA-LABA. A meta-analysis of heterogeneous studies comparing LAMA/LABA with LABA/ICS (Horita et al., 2017) concluded that LAMA/LABA has fewer exacerbations, a larger improvement of FEV 1, a lower risk of pneumonia, and more frequent improvement in quality of life indicators. Patients initiating LAMA-LABA-ICS were matched 4:1 on time-conditional propensity scores with patients initiating LAMA-LABA, and followed for 1 year for the occurrence of a moderate or severe COPD exacerbation and severe pneumonia. ![]() We identified a cohort of patients with COPD during 2002 through 2015, ≥ 55 years of age, from the UK's Clinical Practice Research Datalink. If there has been no improvement, step back down to a LAMA and LABA combination. If symptoms have improved, continue triple therapy and review at least annually. We compared the effectiveness and safety of triple therapy with a LAMA-LABA combination in a real-world clinical practice setting. In patients on a LAMA and LABA whose day-to-day symptoms continue to adversely impact their quality of life, consider trialling the addition of an ICS for 3 months. Please note different strengths may be different colours from those illustrated. Triple therapy combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta 2-agonist (LABA), and an inhaled corticosteroid (ICS) for COPD were studied in randomized trials and observational studies, with variable results. Combination LABA/LAMA Inhalers Spacer Devices 283482 Examples of different inhaler devices are illustrated to aid identification. ![]()
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