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Review
. 2020 Oct 28:15:2695-2705.
doi: 10.2147/COPD.S273987. eCollection 2020.

Dual Bronchodilator in the Era of Triple Therapy

Andriana I Papaioannou  1 , Stelios Loukides  1 , Petros Bakakos  2 , Epameinondas N Kosmas  3 , Nikoletta Rovina  2 , Paschalis Steiropoulos  4 , Evangellia Fouka  5 , Georgios Hillas  6 , Georgios Patentalakis  7 , Marousa Kouvela  7 , Nikos Tzanakis  8
Affiliations
Review

Dual Bronchodilator in the Era of Triple Therapy

Andriana I Papaioannou et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Pharmacological medications used for the treatment of COPD patients have increased significantly. Long-acting bronchodilators have been recognized as the mainstay of the treatment of stable COPD, while ICS are usually added in patients with COPD who experience exacerbations, despite bronchodilator treatment. In the latest years, several studies have been published showing the beneficial effect of adding ICS on dual bronchodilation in patients suffering from more severe disease comparing triple therapy with several therapeutic regiments including dual bronchodilation and providing a message that this triple therapy might be more appropriate for COPD patients. However, not all COPD patients have a desirable response to ICS treatment while long-term ICS use in COPD is associated with several side effects. In this report, we aimed to provide a review of the current knowledge on the importance of dual bronchodilation on COPD patients and to compare its use with triple therapy, by covering a wide spectrum of topics. Finally, we propose an algorithm on performing treatment step up from dual bronchodilation to triple therapy and step down from triple to double bronchodilation considering the current evidence.

Keywords: chronic obstructive pulmonary disease; dual bronchodilation; inhaled corticosteroids; triple therapy.

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Conflict of interest statement

AIP has received Fees and honoraria from Menarini, GSK, Novartis, Elpen, Boehringer Ingelheim, AstraZeneca and Chiesi. SL has received Fees and honoraria from Novartis, AstraZeneca, Sanofi, Menarini, Chiesi, Elpen, Boehringer Ingelheim and GSK. PB has received Fees and Honorara from GSK, AstraZeneca, Novartis, Elpen, Chiesi, Boehringer Ingelheim and Sanofi. EK has received Speaker fees, advisory board honoraria, travel expenses, and fees for clinical trials from AstraZeneca, Angelini, Novartis, GSK, Boehringer Ingelheim, CSL Behring, Chiesi, Elpen, Menarini, Vocate, and Resmed. NR has received honoraria from GSK, AstraZeneca, Chiesi, Elpen, Boehringer Ingelheim, and Novartis. PS has received Fees and Honoraria from Menarini, Boehringer Ingelheim, Elpen, AstraZeneca, Chiesi, GSK and Novartis. EF has received Fees and Honoraria from Chiesi, GSK, Menarini, Novartis, AstraZeneca, Boehringer and Elpen. GH has received Fees and Honoraria from Pharmathen, AstraZeneca, Boehringer Ingelheim, GSK, CSL Behring, Elpen, Chiesi, Innovis, Menarini, Novartis, and UCB. GP is a Boehringer Ingelheim employee. MK has received honoraria from Sanofi, Boehringer Ingelheim and BMS. NT has received Fees and honoraria from Pharmathen, AstraZeneca, GSK, Menarini, Pfizer, Elpen, Chiesi, Boehringer Ingelheim, Novartis, and Inovis. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Algorithm of escalating to and de-escalating from triple therapy. Notes: Consider escalation/de-escalation if the patient has any of the characteristics shown in this Figure.
See this image and copyright information in PMC

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