Triple inhaled therapy in stable chronic obstructive pulmonary disease: The earlier, the better?

Inhaled long-acting bronchodilators (of β2-agonist or muscarinic antagonist type) or corticosteroids are used in stable chronic obstructive pulmonary disease (COPD) treatment in a step-up approach according to disease severity. Consequently, in more severe disease triple therapy with two bronchodilators and an inhaled corticosteroid can often be encountered in clinical practice, but its short-and long-term effects on disease outcomes are not very well known. The results of a study evaluating the short-term effects of budesonide/formoterol (inhaled corticosteroid/inhaled long-acting β2-agonist combination) and tiotropium (inhaled long-acting muscarinic antagonist) against tiotropium alone are analysed and discussed. On a short-term basis, triple therapy improves lung function, health status and disease morbidity irrespective of disease severity. Long-term benefits of triple inhaled therapy including the effects of its precocious use in less severe COPD subjects should be evaluated.