LAUSR

The pharmacological treatment of chronic obstructive pulmonary disease (COPD) focuses on 2 main objectives: controlling symptoms (in the form of reduced symptoms, improved exercise tolerance, and better quality of life) and reducing future risk (understood as reduced frequency and severity of exacerbations, improved long-term prognosis, and modification of lung function decline).1,2 If a drug is to be approved by the regulatory authorities for COPD, it must be effective in at least some of these areas. Inhaled drugs used in COPD can be combined in various ways to increase their clinical efficacy, without increasing side effects. Several options are available, but the most widely used in Spain is the association of a 2-adrenergic agonist (LABA) with a long-acting muscarinic antagonist (LAMA) and an inhaled corticosteroid (ICS). This combination is known as triple therapy (TT).3 National clinical practice guidelines (GesEPOC) and international recommendations (GOLD) both advocate the use of TT in patients presenting frequent exacerbations despite treatment with 2 bronchodilators, or in those who present features of asthma-COPD overlap (ACO), but do not achieve control with a combination of LABA/ICS.1,2 This combination can currently only be achieved in Spain by using 2 inhalers, one containing a LAMA, and the other containing a LABA/ICS combination. Until recently, however, evidence supporting its use was based only on a very few, albeit well-designed, studies.4 Three TT combinations in single inhalation devices are currently being developed: beclomethasone/formoterol/glycopyrronium, fluticasone furoate/vilanterol/umeclidinium, and budesonide/formoterol/glycopyrronium. To date, the only published results on TT are from the combination of beclomethasone/formoterol/glycopyrronium compared to tiotropium5 (TRINITY study) and beclomethasone/formoterol6 (TRILOGY study), both 52 weeks in duration, and a 24-week trial of the triple combination of fluticasone furoate/vilanterol/umeclidinium, with a 52-week extension in a patient subgroup, compared