COPD Triple Therapy: Single- vs Multiple-Inhaler Outcomes

inhalers asthma COPD
In COPD, how does using single-inhaler triple therapy instead of multiple-inhaler triple therapy affect health care costs, mortality, and treatment adherence?

In patients with chronic obstructive pulmonary disease (COPD), use of single-inhaler triple therapy instead of multiple-inhaler triple therapy resulted in reduced health care costs, lower mortality rates, and fewer exacerbations, according to results of an analysis published in Chest.

COPD, the third leading cause of death worldwide, is repeatedly characterized by worsening exacerbations, noted study authors. Inhaled corticosteroids are often prescribed for frequent exacerbations when bronchodilator therapy is inadequate. Investigators in Spain sought to compare how the use of single-inhaler triple therapy (SITT) vs multiple-inhaler triple therapy (MITT) affected health care resource utilization, exacerbations, and persistence (ie, ongoing treatment adherence).

The investigators conducted a real-world, observational, retrospective cohort study from June, 2018 through December 2019 that included 4625 patients with COPD and at least 40 years of age who initiated SITT (n=1011) or MITT (n=3614 patients using 2 or 3 inhalers) culled from electronic health records in the Spanish National Healthcare System database. Baseline characteristics of both cohorts were similar, and the overall mean age was about 71 years (73.9% male); the airflow limitation of most patients was moderate (62.0%) or severe (26.5%).

At the 1-year follow-up, the SITT cohort showed fewer gaps in treatment (hazard ratio [HR]=1.37; 95% CI,1.22-1.53; P <.001), reduced risk of exacerbations (HR=0.68; 95% CI, 0.61-0.77; P =.001), and lower all-cause mortality risk (HR=0.67; 95% CI, 0.63-0.71; P =.027), vs the MITT cohort. Significantly reduced health care resource use and adjusted mean annual cost savings was associated with the SITT cohort. In both cohorts, persistence was associated with better exacerbation rates than nonpersistence.

Study limitations included the variable quality of electronic health care records, the absence of specific symptom data, the measurement of persistence via prescriptions filled instead of actual use, basing exacerbation diagnosis on drug claims and hospital admissions instead of direct physician observation, and the inability to determine COPD deaths from the data used.

Investigators concluded that “Patients initiating SITT had a clinically relevant improvement in persistence leading to reductions in mortality, incidence of exacerbations and healthcare resource use with consequent mean cost savings.”

Disclosure: This research was supported by AstraZeneca Farmacéutica Spain, SA. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Alcázar-Navarrete B, Jamart L, Sánchez-Covisa J, Juárez M, Graefenhain R, Sicras-Mainar A. Clinical characteristics, treatment persistence and outcomes among patients with COPD treated with single- or multiple-inhaler triple therapy: a retrospective analysis in Spain. Chest. Published online July 1, 2022. doi:10.1016/j.chest.2022.06.033