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Triple therapy hope for COPD

Respiratory specialists are looking to a ‘triple therapy' of two bronchodilators plus an inhaled steroid as the best treatment for COPD.

INSPIRE, a study comparing the long-acting anticholinergic bronchodilator tiotropium with a combination of long-acting ß-agonist salmeterol and inhaled steroid fluticasone in 1,323 patients, found little to choose between the two treatments.

But they appeared to work in different ways, suggesting large trials might show a benefit from combining all three.

The study found a lower level of mortality (3%) in those on the combination compared with those taking tiotropium alone (5%), but those on the combination were more likely to develop pneumonia (5% against 3% in tiotropium).

INSPIRE researcher Professor Wisia Wedzicha, head of respiratory medicine at University College London, said: ‘When we started this trial the idea of combinations was in its infancy. What we need is studies comparing different combinations including triple therapy.'

Professor Peter Calverley, head of respiratory medicine at the University of Liverpool, said: ‘We need to know how much benefit people get from adding a long-acting anticholinergic to an inhaled steroid with or without a second bronchodilator. I am sure we will see studies over the next few years.'

A study of triple therapy's effects on lung function found it improved bronchodilation, as measured by a series of spirometric measures including FEV1. Triple therapy was also associated with use of significantly less rescue medication.

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