Single inhaler #triple therapy versus inhaled corticosteroid plus long-acting β2-agonist therapy for chronic #obstructive pulmonary disease (TRILOGY): a double-blind, parallel group, randomised controlled trial

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31354-X/abstract

Interpretation
We provide evidence for the clinical benefits of stepping up patients with COPD from an inhaled corticosteroid/long-acting β2-agonist combination treatment to triple therapy using a single inhaler.

Diagnostic Yield of #Triple-Rule-Out CT in an #Emergency Setting

http://www.ajronline.org/doi/abs/10.2214/AJR.15.15717?journalCode=ajr
CONCLUSION. In 8.9% of patients, TRO CT detected a significant noncoronary diagnosis that could explain acute chest pain, including pathologic findings that would not be identified on dedicated coronary CT angiography.

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Once-Daily Single-Inhaler #Triple versus Dual Therapy in Patients with #COPD

https://www.nejm.org/doi/full/10.1056/NEJMoa1713901?query=featured_home


The rate of moderate or severe exacerbations in the triple-therapy group was 0.91 per year, as compared with 1.07 per year in the fluticasone furoate–vilanterol group (rate ratio with triple therapy, 0.85; 95% confidence interval CI, 0.80 to 0.90; 15% difference; P<0.001) and 1.21 per year in the umeclidinium–vilanterol group (rate ratio with triple therapy, 0.75; 95% CI, 0.70 to 0.81; 25% difference; P<0.001). The annual rate of severe exacerbations resulting in hospitalization in the triple-therapy group was 0.13, as compared with 0.19 in the umeclidinium–vilanterol group (rate ratio, 0.66; 95% CI, 0.56 to 0.78; 34% difference; P<0.001). There was a higher incidence of pneumonia in the inhaled-glucocorticoid groups than in the umeclidinium–vilanterol group, and the risk of clinician-diagnosed pneumonia was significantly higher with triple therapy than with umeclidinium–vilanterol, as assessed in a time-to-first-event analysis (hazard ratio, 1.53; 95% CI, 1.22 to 1.92; P<0.001).

CONCLUSIONS
Triple therapy with fluticasone furoate, umeclidinium, and vilanterol resulted in a lower rate of moderate or severe COPD exacerbations than fluticasone furoate–vilanterol or umeclidinium–vilanterol in this population. Triple therapy also resulted in a lower rate of hospitalization due to COPD than umeclidinium–vilanterol.

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#Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis

https://www.bmj.com/content/363/bmj.k4388

21 trials (19 publications) were included. Triple therapy consisted of a long acting muscarinic antagonist (LAMA), long acting β agonist (LABA), and inhaled corticosteroid (ICS). Triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71, 95% confidence interval 0.60 to 0.85), LAMA and LABA (0.78, 0.70 to 0.88), and ICS and LABA (0.77, 0.66 to 0.91). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favourable with triple therapy.

The overall safety profile of triple therapy is reassuring, but #pneumonia was significantly higher with triple therapy than with dual therapy of LAMA and LABA (relative risk 1.53, 95% confidence interval 1.25 to 1.87).

Conclusions Use of triple therapy resulted in a lower rate of moderate or severe exacerbations of #COPD, better lung function, and better health related quality of life than dual therapy or monotherapy in patients with advanced COPD.