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. 2025 Jul 21;40(28):e147.
doi: 10.3346/jkms.2025.40.e147.

Effects of Triple Therapy on the Clinical Course of Non-Eosinophilic COPD Groups B

Jin Hwa Song  1 , Shinhee Park  2 , Jong Geol Jang  3 , Youlim Kim  4 , Seung Won Ra  5 , Chang Youl Lee  6 , Deog Kyeom Kim  7 , Hyoung Kyu Yoon  8 , Kwang Ha Yoo  4 , Hee Joung Kim  9
Affiliations

Effects of Triple Therapy on the Clinical Course of Non-Eosinophilic COPD Groups B

Jin Hwa Song et al. J Korean Med Sci. .

Abstract

Background: Although the efficacy of triple therapy in treating chronic obstructive pulmonary disease (COPD) patients with a history of exacerbation is well established in groups with frequent exacerbations, less research has been conducted on its use in group B. Here, we investigated the effects of triple therapy on COPD patients with low eosinophil counts in the context of the current management of group B.

Methods: Using data from the Korean COPD Subtype Study (KOCOSS), we selected patients with blood eosinophil count (BEC) less than 300 cells/μL as non-eosinophilic COPD groups. The study evaluated the effect of a triple therapy group (combination of inhaled corticosteroid, a long-acting β2-agonist [LABA] and a long-acting muscarinic antagonist [LAMA]) and a dual therapy group (LABA/LAMA) on moderate-to-severe exacerbations, as well as longitudinal changes in lung function over 3 years in patients categorized as Global Initiative for Chronic Obstructive Lung Disease (GOLD) B.

Results: Of the 328 non-eosinophilic COPD group B, 145 (44.2%) patients were in triple therapy and 183 (55.8%) patients were in dual therapy. Triple therapy group showed an increased risk of moderate-to-severe exacerbation in multivariate adjusted model (adjusted incidence rate ratio of annual rate, 2.04; 95% confidence interval, 1.45 to 2.84; P < 0.001). Similarly, restricted cubic spline regression analysis of annual rates of moderate-to-severe exacerbations suggested an increased risk associated with the triple therapy over dual therapy in BEC lower than 300 cells/μL. There was no significant difference in the adjusted rate of forced expiratory volume in 1 second decline between triple therapy group and dual therapy group (-10.0 [-39.8 to -19.7] mL/year vs. 22.3 [-4.4 to -49.0] mL/year, P for interaction = 0.888).

Conclusion: In conclusion, our research suggests that triple therapy was associated with a higher risk of moderate-to-severe exacerbations in non-eosinophilic COPD categorized as GOLD B compared with dual therapy.

Keywords: Bronchodilator Agents; KOCOSS Cohort; Pulmonary Disease, Chronic Obstructive; Registries.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Flow chart of study population selection.
KOCOSS = Korean Chronic Obstructive Pulmonary Disease Subtype Study, BD = bronchodilator, FEV1 = forced expiratory volume in 1 second, FVC = forced vital capacity, GOLD = Global Initiative for Chronic Obstructive Lung Disease, ICS = inhaled corticosteroid, LABA = long-acting beta agonist, LAMA = long-acting muscarinic antagonist.
Fig. 2
Fig. 2. Adjusted incidence rate ratio of moderate-to-severe exacerbations according to triple therapy versus dual therapy at different eosinophil levels in group B COPD patients. Adjusted for age, sex, body mass index, total pack-year of smoking, previous experience of moderate exacerbation, baseline trough forced expiratory volume in a second, and total St George’s Respiratory Questionnaire score.
COPD = chronic obstructive pulmonary disease, IRR = incidence rate ratio, CI = confidence interval.
See this image and copyright information in PMC

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