Triple combinations in chronic obstructive pulmonary disease - is three better than two?

A growing body of evidence suggests that triple therapy with an antimuscarinic agent, a long-acting β2-agonist, and an inhaled corticosteroid is efficacious in patients with more severe chronic obstructive pulmonary disease (COPD), such as those with frequent exacerbations. Moreover, this therapy is often prescribed in real-life management of COPD, even in patients who are not suffering from severe COPD. All this makes triple therapy an attractive therapeutic approach. Therefore, a variety of triple combinations are currently under development. However, there are a number of issues that need to be addressed in order to optimize the use of triple therapy in COPD because data are still too scarce and studies too short to generate a strong recommendation.