Few feelings are as frightening as the inability to breathe, something experienced by most people with COPD, chronic obstructive pulmonary disease. The focus of COPD care is medication-based treatment to avoid breath-robbing flare-ups called “exacerbations,” usually using one or two inhaled drugs. But what if that’s just not enough? The answer, triple therapy, can help, but it can come at a health cost, as new research shows.

Background: Patients diagnosed with COPD are often started on single inhaler, usually a long-acting beta 2 adrenoceptor agonist (LABA) or a long-acting muscarinic receptor antagonist (LAMA). If COPD is not well controlled, treatment might step up to either using both of those or one of those plus an inhaled corticosteroid. If exacerbations remain a problem, an aggressive form of treatment is to prescribe all three drugs, which has become a common practice. They can be given with a single inhaler, which is easier on the patient and reduces the risk of dosing errors. But despite widespread use of triple therapy for COPD, questions remain about just how effective—and safe—it is.

Latest research: To answer these questions, researchers analyzed the findings of 21 controlled trials that compared triple therapy to one- or two-drug therapy in patients with COPD.

First the good news: They confirmed that triple therapy reduces exacerbations, improves breathing and improves quality of life compared with either one- or two-drug therapy…and by 25%.

Now the bad news: Triple therapy also increases the risk for pneumonia because of the corticosteroid, a drug known to increase pneumonia risk in anyone with COPD who takes it. The risk for pneumonia is 50% higher than with the two-drug therapy using LABA and LAMA. Since the risk for pneumonia for anyone with severe COPD is already high due to physical changes that make it harder for the body to fight off infection, a 50% increased risk could be a significant health threat.

Another finding was that triple therapy didn’t improve overall survival, so while it’s effective, it should be reserved for people with severe COPD who do not respond well to two-drug therapy.


If your COPD is serious enough to warrant triple drug therapy, take all the steps you can to avoid pneumonia. These are simple enough and bear repeating…

  • Get your flu, pneumonia and pertussis vaccine shots.
  • Wash your hands frequently with soap and water or use a hand sanitizer.
  • Avoid crowds during cold and flu season.
  • Don’t visit sick loved ones, and yes, even your grandkids.
  • Get plenty of sleep.
  • Drink plenty of water.

 For more ways to prevent pneumonia, read “Don’t Let the Flu Turn into Pneumonia.”

If you develop symptoms of pneumonia, let your doctor know right away. Some can be similar to an exacerbation, with cough, difficulty breathing and thick or discolored mucus. But with pneumonia, you may also have fever and chills, nausea and vomiting, a rapid heartbeat and/or pain in your chest when you take deep breaths.

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