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When to use single-inhaler triple therapy in COPD: a practical approach for primary care health care professionals.

作者信息

Gaduzo S, McGovern V, Roberts J, Scullion J E, Singh D

机构信息

Stockport NHS Foundation Trust, Stockport, UK.

Belfast Trust, Belfast, UK.

出版信息

Int J Chron Obstruct Pulmon Dis. 2019 Feb 13;14:391-401. doi: 10.2147/COPD.S173901. eCollection 2019.


DOI:10.2147/COPD.S173901
PMID:30863039
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6388781/
Abstract

While single-inhaler triple therapy (SITT) devices were not available when the Global Initiative for Chronic Obstructive Lung Disease strategy and National Institute for Health and Care Excellence guidelines were developed, two devices are now available in the UK. This paper offers practical, patient-focused advice to optimize placement of SITT in the management of COPD. A survey of UK health care professionals (HCPs) identified issues around, and attitudes toward, SITT, which informed a multidisciplinary expert panel's discussions. The survey confirmed the need to clarify the place of SITT in COPD management. The panel suggested three criteria, any one of which identifies a high-risk patient where escalation to triple therapy from monotherapy or double combination treatment is appropriate: 1) at least two exacerbations treated with oral corticosteroids, antibiotics, or both in the previous year; 2) at least one severe exacerbation that required hospital admission in the previous year; 3) one exacerbation a year on a repeated basis for 2 consecutive years. Appropriate non-pharmacological management is essential for all patients and should be considered before stepping up treatment. Regular review is essential. During each review, HCPs should consider stepping treatment up or down. If patients exacerbate despite adhering to triple therapy, an individualized approach should be considered if the inhaled corticosteroid (ICS) confers benefit or causes side effects. In this situation, the blood eosinophil count could aid decision making. ICSs should be continued when the history suggests that asthma overlaps with COPD. Training, counseling, and education should be individualized. HCPs should consider referral: 1) when there is limited response to treatment and persistent exacerbations; 2) where there is diagnostic uncertainty or suspected comorbidity; 3) whenever they feel "out of their depth." Overall, the panel concurred that when used correctly, SITT has the potential to improve adherence, symptom control, and quality of life, and reduce exacerbations. Studies using real-world evidence need to confirm these benefits.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c86c/6388781/6a52d522c847/copd-14-391Fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c86c/6388781/a969b093b10b/copd-14-391Fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c86c/6388781/51ae9452bfae/copd-14-391Fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c86c/6388781/6a52d522c847/copd-14-391Fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c86c/6388781/a969b093b10b/copd-14-391Fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c86c/6388781/51ae9452bfae/copd-14-391Fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c86c/6388781/6a52d522c847/copd-14-391Fig3.jpg

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[2]
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[3]
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引用本文的文献

[1]
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Adv Ther. 2025-7-7

[2]
Real-World Effectiveness of Single-Inhaler Triple Treatment Through Assorted Respiratory Outcomes When Switched From Multiple-Inhaler Triple Therapies (RESTART): A Prospective Cohort Study of Korean Patients With COPD.

Int J Chron Obstruct Pulmon Dis. 2025-4-11

[3]
Effectiveness of Switching from Multiple-Inhaler to Once-Daily Single-Inhaler Triple Therapy in Patients with COPD in a Real-World Setting in Japan.

Int J Chron Obstruct Pulmon Dis. 2025-3-8

[4]
Comparative adherence and persistence of single-inhaler and multiple-inhaler triple therapies among patients with chronic obstructive pulmonary disease in Japan: a retrospective cohort study.

BMJ Open. 2024-12-4

[5]
Evaluation of Adherence and Persistence to Triple Therapy in Patients with COPD: A German Claims Data Study.

Int J Chron Obstruct Pulmon Dis. 2024

[6]
Characteristics of Users and New Initiators of Single- and Multiple-Inhaler Triple Therapy for Chronic Obstructive Pulmonary Disease in Germany.

Int J Chron Obstruct Pulmon Dis. 2024-4-17

[7]
Outcomes Following Initiation of Triple Therapy with Fluticasone Furoate/Umeclidinium/Vilanterol versus Multiple-Inhaler Triple Therapy Among Medicare Advantage with Part D Beneficiaries and Those Commercially Enrolled for Health Care Insurance in the United States.

Int J Chron Obstruct Pulmon Dis. 2024

[8]
Benefit of Prompt Vs Delayed Initiation of Triple Therapy Following an Exacerbation in Patients with COPD in Japan: A Retrospective Cohort Study.

Int J Chron Obstruct Pulmon Dis. 2023

[9]
Cost-Effectiveness of Single-Inhaler Triple Therapy (FF/UMEC/VI) versus Tiotropium Monotherapy in Patients with Symptomatic Moderate-to-Very Severe COPD in the UK.

Int J Chron Obstruct Pulmon Dis. 2023

[10]
Use and persistence of single and multiple inhaler triple therapy prescribed for patients with COPD in France: a retrospective study on THIN database (OPTI study).

BMJ Open Respir Res. 2023-6

本文引用的文献

[1]
Long-Term Triple Therapy De-escalation to Indacaterol/Glycopyrronium in Patients with Chronic Obstructive Pulmonary Disease (SUNSET): A Randomized, Double-Blind, Triple-Dummy Clinical Trial.

Am J Respir Crit Care Med. 2018-8-1

[2]
Pharmacological treatment of COPD: the devil is always in the detail.

Eur Respir J. 2018-4-19

[3]
Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD.

N Engl J Med. 2018-4-18

[4]
Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial.

Lancet. 2018-2-9

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Single-inhaler fluticasone furoate/umeclidinium/vilanterol versus fluticasone furoate/vilanterol plus umeclidinium using two inhalers for chronic obstructive pulmonary disease: a randomized non-inferiority study.

Respir Res. 2018-1-25

[6]
Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease: a post-hoc analysis of three randomised trials.

Lancet Respir Med. 2018-1-10

[7]
Joint statement for the diagnosis, management, and prevention of chronic obstructive pulmonary disease for Gulf Cooperation Council countries and Middle East-North Africa region, 2017.

Int J Chron Obstruct Pulmon Dis. 2017-10-9

[8]
The risk of mycobacterial infections associated with inhaled corticosteroid use.

Eur Respir J. 2017-9-20

[9]
Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial.

Lancet. 2017-4-3

[10]
FULFIL Trial: Once-Daily Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease.

Am J Respir Crit Care Med. 2017-8-15

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