Statistics from Altmetric.com
Clinical practice guidelines (CPG) for the management of stable chronic obstructive pulmonary disease (COPD) recommend the addition of long-acting bronchodilators for patients who remain symptomatic despite use of short-acting bronchodilators.1 Whether a long-acting muscarinic antagonist (anticholinergic) bronchodilator (LAMA) such as tiotropium or a long-acting β2-agonist bronchodilator (LABA) such as salmeterol, formoterol or indacaterol should be used as initial therapy is a matter of debate.
If symptoms persist despite the use of tiotropium, CPGs recommend adding a LABA. In practice, the LABA added usually includes inhaled corticosteroid (ICS) as a combination inhaler (LABA/ICS: salmeterol/fluticasone or formoterol/budesonide). Occasionally, a LABA/ICS is used instead of tiotropium as initial therapy, although this is not recommended by evidence-based CPGs. Finally, although commonly used for moderate-to-severe COPD, there has been little research into the effectiveness of so-called ‘triple therapy’, namely a LABA/ICS plus LAMA. This commentary examines two recent studies that have attempted to clarify these issues.
In the first study, Vogelmeier et al performed a 1 year, multicentre, randomised placebo-controlled, blinded, double dummy trial comparing the effectiveness of either tiotropium 18 …
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.