Print Get Citation Citation Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy. AMA Citation Shah H, Shroff Karhade D. Shah H, & Shroff Karhade D Shah, Harsh, and Deepti Shroff Karhade. Budesonide triple therapy significantly lowers exacerbation rates in severe COPD. 2 Minute Medicine, 26 June 2020. McGraw-Hill, 2020. AccessMedicine. https://accessmedicine.mhmedical.com/updatesContent.aspx?gbosid=550777§ionid=248337414APA Citation Shah H, Shroff Karhade D. Shah H, & Shroff Karhade D Shah, Harsh, and Deepti Shroff Karhade. (2020). Budesonide triple therapy significantly lowers exacerbation rates in severe copd. (2020). 2 minute medicine. McGraw-Hill. https://accessmedicine.mhmedical.com/updatesContent.aspx?gbosid=550777§ionid=248337414.MLA Citation Shah H, Shroff Karhade D. Shah H, & Shroff Karhade D Shah, Harsh, and Deepti Shroff Karhade. "Budesonide triple therapy significantly lowers exacerbation rates in severe COPD." 2 Minute Medicine McGraw-Hill, 2020, https://accessmedicine.mhmedical.com/updatesContent.aspx?gbosid=550777§ionid=248337414. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Clip Full Chapter Figures Only Tables Only Videos Only Supplementary Content Top Budesonide triple therapy significantly lowers exacerbation rates in severe COPD by Harsh Shah, Deepti Shroff Karhade Listen +Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission. +1. Triple therapy for severe chronic obstructive pulmonary disease (COPD) with budesonide-glycopyrrolate-formoterol was associated with significantly lower risk of COPD exacerbation compared to dual therapy groups. +Evidence Rating Level: 1 (Excellent) Study Rundown: + +Treatment for COPD involves a stepwise approach where treatments are added when necessary to control symptoms and reduce exacerbations. Triple therapy includes an inhaled glucocorticoid, a long-action muscarinic antagonist (LAMA), and a long-acting β2-agonist (LABA). Tripe therapy is recommended for patients continually experiencing exacerbations from dual therapy of LAMA-LABA or inhaled glucocorticoid-LABA. As such, this study compared the efficacy and safety of the triple therapy of budesonide-glycopyrrolate-formoterol combination and two dual therapies, glycopyrrolate-formoterol (LAMA-LABA) and budesonide-formoterol (inhaled glucocorticoid-LABA). The study determined that patients in the triple therapy group had lower rates of exacerbations compared to the patients in the two dual therapy groups. One limitation of this randomized trial was the higher incidence of pneumonia within the patient population compared to previously published randomized control trials regarding COPD therapies. Nonetheless, this study was strengthened by the long-term patient follow-up between the treatment groups. +Click to read the study in NEJM +Relevant Reading: Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD In-Depth [randomized controlled trial]: + +This randomized control trial enrolled 8588 patients in a multicenter study from 25 countries. The study included patients between 40 to 80 years of age, who received at least two inhaled maintenance therapies and had symptomatic COPD. The exclusion criteria for the study included current diagnosis of asthma. The patients were randomized in a 1:1:1:1 ratio to receive 160μg- budesonide triple therapy dose, 320μg- budesonide triple therapy dose, glycopyrrolate-formoterol, or budesonide-formoterol. The primary outcome was the annual rate of moderate to severe COPD exacerbations. Moderate exacerbation was defined as leading to systemic glucocorticoid and/or antibiotic treatment for at least three days. Severe exacerbation was defined as resulting in hospitalization or death. The annual rate for exacerbations was significantly lower with 320μg- budesonide triple therapy dose compared to glycopyrrolate-formoterol (rate ratio, 0.76; 95% confidence interval [CI], 0.69 to 0.83, P<0.0001) and budesonide-formoterol (rate ratio, 0.87; 95% CI, 0.79 to 0.95; P=0.003). Furthermore, no difference was observed between the two triple therapies (rate ratio: 1.00, 95% CI, 0.91 to 1.10). Finally, the risk of death from any cause in the 320μg triple therapy group was 46% lower than the glycopyrrolate-formoterol group (hazard ratio, 0.54; 95% CI, 0.34 to 0.87) and 22% lower than the budesonide-formoterol group (hazard ratio, 0.78; 95% CI, 0.47 to 1.30). Taken together, administration of triple therapy of budesonide-glycopyrrolate-formoterol significantly lowered rates of exacerbations in patients with moderate or severe COPD. +©2020 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.