Observational studyInternational journal of chronic obstructive pulmonary disease2015
The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK.
Observational study in International journal of chronic obstructive pulmonary disease, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 83 papers, 5 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
83 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Single-inhaler triple therapy in patients with chronic obstructive pulmonary disease: a systematic review.Respiratory research · 2019Pooled it
- Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2018Pooled it
- Systematic Review and Quality Appraisal of Cost-Effectiveness Analyses of Pharmacologic Maintenance Treatment for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Recommendations.PharmacoEconomics · 2017Pooled it
- A Systematic Literature Review of the Humanistic Burden of COPD.International journal of chronic obstructive pulmonary diseasePooled it
- Triple therapy for COPD: a crude analysis from a systematic review of the evidence.Therapeutic advances in respiratory diseasePooled it
- A randomized trial of symptom-based management in Japanese patients with COPD.International journal of chronic obstructive pulmonary disease · 2018Trial
- Budesonide/Glycopyrrolate/Formoterol Fumarate Metered Dose Inhaler Improves Exacerbation Outcomes in Patients with COPD without a Recent Exacerbation History: A Subgroup Analysis of KRONOS.International journal of chronic obstructive pulmonary diseaseTrial
- Real-World Outcomes in Patients with COPD Initiating Budesonide/Glycopyrronium/Formoterol Fumarate Dihydrate After Dual and Triple Therapy in Spain: A Sub-Study of the ORESTES Study.Pulmonary therapy · 2026Article
- Exacerbations and Lung Function in Polish Patients with Chronic Obstructive Pulmonary Disease Treated with ICS/LABA: 2-Year Prospective, Observational Study.Journal of clinical medicine · 2025Article
- Single-Inhaler Triple Therapy in Primary Care Across Europe: Expert Panel Consensus on the Consequences of Payer-Driven Access Rules and Call to Action.International journal of chronic obstructive pulmonary disease · 2025Review
- Blood eosinophil count and treatment patterns of chronic obstructive pulmonary disease patients in South Korea using real-world data.The Korean journal of internal medicine · 2025Article
- Treatment Decisions for Stable Chronic Obstructive Pulmonary Disease in China: An Observational Cross-Sectional Survey Based on Multivariate Discrete Choice Modeling.International journal of chronic obstructive pulmonary disease · 2025Observational
- Effects of triple therapy on disease burden in patients of GOLD groups C and D: results from the observational COPD cohort COSYCONET.BMC pulmonary medicine · 2024Observational
- Characteristics of Users and New Initiators of Single- and Multiple-Inhaler Triple Therapy for Chronic Obstructive Pulmonary Disease in Germany.International journal of chronic obstructive pulmonary disease · 2024Article
- Adjustments to maintenance therapy and the reasoning behind them among COPD outpatients in Austria: the STEP study.ERJ open research · 2024Article
- Rational use of inhaled corticosteroids for the treatment of COPD.NPJ primary care respiratory medicine · 2023Review
- Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study.NPJ primary care respiratory medicine · 2023Article
- Treatment patterns and cost of exacerbations in patients with chronic obstructive pulmonary disease using multiple inhaler triple therapy in South Korea.Respiratory research · 2022Article
- A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients.NPJ primary care respiratory medicine · 2022Article
- Article
23 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundReal-world prescription pathways leading to triple therapy (TT) (inhaled corticosteroid [ICS] plus long-acting β2-agonist bronchodilator [LABA] plus long-acting muscarinic antagonist) differ from Global initiative for chronic Obstructive Lung Disease [GOLD] and National Institute for Health and Care Excellence treatment recommendations. This study sets out to identify COPD patients without asthma receiving TT, and determine the pathways taken from diagnosis to the first prescription of TT.
methodsThis was a historical analysis of COPD patients without asthma from the Optimum Patient Care Research Database (387 primary-care practices across the UK) from 2002 to 2010. Patient disease severity was classified using GOLD 2013 criteria. Data were analyzed to determine prescribing of TT before, at, and after COPD diagnosis; the average time taken to receive TT; and the impact of lung function grade, modified Medical Research Council dyspnea score, and exacerbation history on the pathway to TT.
resultsDuring the study period, 32% of patients received TT. Of these, 19%, 28%, 37%, and 46% of patients classified as GOLD A, B, C, and D, respectively, progressed to TT after diagnosis (P<0.001). Of all patients prescribed TT, 25% were prescribed TT within 1 year of diagnosis, irrespective of GOLD classification (P=0.065). The most common prescription pathway to TT was LABA plus ICS. It was observed that exacerbation history did influence the pathway of LABA plus ICS to TT.
conclusionReal life UK prescription data demonstrates the inappropriate prescribing of TT and confirms that starting patients on ICS plus LABA results in the inevitable drift to overuse of TT. This study highlights the need for dissemination and implementation of COPD guidelines to physicians, ensuring that patients receive the recommended therapy.
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