Triple inhaled therapy in stable chronic obstructive pulmonary disease: the earlier, the better? Evaluation of Welte T, Miravitlles M, Hernandez P, et al. Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009;180:741-50.

摘要

Inhaled long-acting bronchodilators (of p2-agonist or muscarinic antagonist type) or corticosteroids are used in stable chronic obstructive pulmonary disease (COPD) treatment in a step-up approach according to disease severity. Consequently, in more severe disease triple therapy with two bronchodilators and an inhaled corticosteroid can often be encountered in clinical practice, but its short- and long-term effects on disease outcomes are not very well known. The results of a study evaluating the short-term effects of budesonide/ formoterol (inhaled corticosteroid/inhaled long-acting (32-agonist combination) and tiotropium (inhaled long-acting muscarinic antagonist) against tiotropium alone are analysed and discussed. On a short-term basis, triple therapy improves lung function, health status and disease morbidity irrespective of disease severity. Long-term benefits of triple inhaled therapy including the effects of its precocious use in less severe COPD subjects, should be evaluated.