CHEST Guidelines-Observational-Data-With-Inhaled-Corticosteroid-Lon

Observational-Data-With-Inhaled-Corticosteroid-Lon

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The document features a correspondence and response surrounding a study on the effectiveness of triple therapy in patients with chronic obstructive pulmonary disease (COPD). This study by Suissa et al. published in CHEST evaluated the benefits of using a combination of inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), and long-acting muscarinic antagonist (LAMA) in comparison to using LABA/LAMA alone. Findings indicated that triple therapy was more effective in reducing exacerbations for patients with significant eosinophilia or frequent exacerbations but posed a higher risk of pneumonia. <br /><br />Lipworth et al. respond to this study by highlighting that the data used were collected at a time when the medications were administered using separate inhalers, and therefore may not entirely reflect the current real-world scenario where single triple inhalers are available. They stress that adherence to the treatment would potentially be higher with a single inhaler versus multiple, suggesting that the study’s findings may not exactly translate to present practices. Additionally, they propose further analyses that consider combined criteria based on both eosinophil counts and exacerbations, which could provide deeper insights if feasible data exist.<br /><br />In response, Suissa et al. acknowledge the comments, but indicate that further analysis as suggested by Lipworth et al. is constrained by data limitations, specifically the number of patients fitting the criteria of high eosinophilia and frequent exacerbations. Despite these limitations, the study emphasizes the superior effectiveness of triple therapy in selective patient groups with COPD but also notes the increased risk of pneumonia associated with its use.

Keywords

COPD

triple therapy

inhaled corticosteroid

long-acting beta-agonist

long-acting muscarinic antagonist

exacerbations

eosinophilia

pneumonia risk

single inhaler

treatment adherence