Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a group of diseases defined by airflow blockage and breathing related problems (cough, dyspnea, sputum production). COPD is currently a leading cause of morbidity and mortality, causing 3.23 million deaths in 2019 [1]. Three main classes of drugs are commonly used alone and in combination to manage COPD: long-acting betaadrenoceptor agonists (LABA), long-acting muscarinic antagonists (LAMA) and inhaled corticosteroids (ICS). The combination of all three drug classes are reserved for patients with persistent symptoms despite the use of dual inhaled therapy. The triple therapies available in a single inhaler approved in the United States include: fluticasone/vilanterol/umeclidinium, budesonide/glycopyrronium/formoterol.
Methods: 585 hospitalized patients, taking a form of triple inhaled therapy, admitted for COPD exacerbation or respiratory failure were studied. Due to small sample size, Chi-square test was used to compare the incidence rate of rehospitalization between those taking either medications. The outcome measured in this study was oxygen requirements, readmissions, mortality, ICU admission, and hospital length of stay.
Results: When comparing patients admitted for COPD exacerbation and/or respiratory failure, there was no statistically significant differences between those previously taking fluticasone/vilanterol/umeclidinium, and budesonide/glycopyrronium/formoterol. Readmission rates were similar between the two groups (77 [14.64%] versus 8 [13.56%]; P=0.8235). Furthermore, there was no statistically significant differences when assessing mortality (1 [0.19%] versus 0 [0.00%]; P=1.00), ICU admission (36 [6.84%] versus 4 [6.78%]; P=1.00), and length of stay (3 days versus 3 days).
Conclusions: The study suggests that there are no statistically significant differences between those taking fluticasone/vilanterol/umeclidinium, and budesonide/glycopyrronium/formoterol in reducing hospitalizations. Furthermore, the study does not account for patients who are noncompliant on triple inhaled therapy and those who were treated in the outpatient setting. A prospective cohort study would be more beneficial in establishing a superior form of triple inhaled therapy.
