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Medicineworld.org: Triple therapy for COPD

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Triple therapy for COPD




Patients with moderate to severe chronic obstructive pulmonary disease (COPD) can benefit from triple treatment that includes a long-acting β-agonist (LABA), an inhaled corticosteroid (ICS) and an anti-muscarinic agent, as per scientists in Gera number of.

In the study, which will appear in the October 15 issue of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, scientists observed that adding budesonide, an ICS, and formoterol, a LABA, to the anti-muscarinic agent, tiotropium, reduced the rate of severe exacerbations in COPD patients by 62 percent. Triple treatment also resulted in significant improvements on many outcome parameters in COPD patients, including lung function, signs and symptoms, and quality of life.



Triple therapy for COPD

"This approach is of interest because the goal of COPD management is to achieve optimal control," wrote main author, Prof. Tobias Welte, M.D., head of the Department of Respiratory Medicine of the Hannover Medical School in Gera number of.

While current guidelines suggest using both LABA and/or muscarinic antagonists and ICS in only a small number of patients, triple treatment is more widely used in clinical practice than officially recommended, but the benefits have never been demonstrated in a randomized controlled trial.

"We wanted to evaluate the effect of budesonide/formoterol combined with the tiotropium on lung function, patient-centered clinical outcomes (symptoms, health-related quality of life, exacerbations and morning activities), and tolerability in patients with COPD," said Dr. Welte.

The scientists recruited more than 600 patients with moderate to severe COPD to participate in the randomized, double-blind, multi-center, parallel group trial. Previous to the beginning of the study, enrolled patients stopped their use of LABA and ICS medications for two and four weeks respectively. Two weeks previous to the start of the trial, every patient was given a tiotropium (18 μg) inhaler to use daily and as needed as a reliever medication. Patients were then randomized to use either tiotropium plus budesonide and formoterol or tiotropium plus placebo twice daily. They were assessed at the beginning of the run-in period, then at weeks zero, one, six and 12.

After one week, patients on triple treatment increased their pre-dose FEV1 clinic values by six percent over than patients on tritropium alone. There was an even greater improvement in post-dose readings among triple-therapy patients, which were about 12 percent better than those on tiotropium alone.

Onset of symptom relief was also significantly quicker in the triple treatment group. "In some cases, we observed that patients experienced an almost immediate relief, whereas those who were treated with placebo had a greater lag time between dosing and relief," said Dr. Welte.

Health status in the triple treatment group, as measured by the St. George's Respiratory Questionnaire for COPD (SGRQ-C) improved on average by 3.8 units. While four points is considered the minimum clinically relevant increment in most studies, more than half of triple treatment patients, as in comparison to 40 percent of placebo patients, experienced the clinically significant four-point-or-greater increase in SGRQ-C scores.

The scientists also found significant improvements in morning activities in the triple treatment group, beginning at one week and sustained throughout. "Patients could easier wash themselves, get dressed, eat breakfast and walk around early in the morning," said Dr. Welte.

But perhaps most significantly, the triple treatment therapy group had fewer than half the severe exacerbations of the placebo group. In the triple treatment group, 7.6 percent experienced severe exacerbations, in comparison to 18.5 percent in the placebo group. Those in the triple treatment therapy group also had fewer hospitalizations and a longer time to hospitalization than the placebo group.

"This is the first clinical study to directly evaluate the clinical efficacy of combining budesonide/formoterol with tiotropium in patients with COPD," said Dr. Welte. "This therapy approach was linked to marked improvements in various evaluations at the clinic and at home in the morning compared with tiotropium alone. In addition, a significant 62-percent reduction was seen in severe exacerbations. Future research will evaluate the differences between triple and double (formoterol/tiotropium) treatment, may use longer study periods, andin basic research experimentswill try to explain why the triple treatment is so successful".


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Did you know?
Patients with moderate to severe chronic obstructive pulmonary disease (COPD) can benefit from triple treatment that includes a long-acting and#946;-agonist (LABA), an inhaled corticosteroid (ICS) and an anti-muscarinic agent, as per scientists in Gera number of. In the study, which will appear in the October 15 issue of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, scientists observed that adding budesonide, an ICS, and formoterol, a LABA, to the anti-muscarinic agent, tiotropium, reduced the rate of severe exacerbations in COPD patients by 62 percent. Triple treatment also resulted in significant improvements on many outcome parameters in COPD patients, including lung function, signs and symptoms, and quality of life.

Medicineworld.org: Triple therapy for COPD

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