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Triple COPD therapy gains momentum

More evidence that triple inhaled therapy - two bronchodilators and a steroid - is the best treatment for COPD has come from a UK study.

Researchers at the University of Manchester studied 41 COPD patients randomised to receive a salmeterol/fluticasone inhaler, a tiotropium inhaler or both.

Patients on triple therapy saw a 212ml improvement in FEV1 compared with tiotropium alone and 110ml with salmeterol/fluticasone. They also used less rescue medication- one occasion a day less compared to tiotropium and 0.6 with salmeterol/fluticasone. The data comes a month after similar data from the 1,323 patient INSPIRE study.

The authors say that although triple therapy is gaining wider use for COPD patients to optimise lung function, improve symptoms and reduce exacerbations, the evidence base for this approach is limited.

But they add: 'This current study provides an important addition to our knowledge, proving that triple therapy with salmeterol/fluticasone plus tiotropium is more effective than salmeterol/fluticasone alone or tiotropium alone in terms of pulmonary function. Adequately powered, long term studies of the benefits of triple therapy on exacerbation rates and other clinical endpoints are now needed to fully justify this approach in clinical practice.'

Thorax published online

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