ArticleTherapeutic advances in respiratory disease
Prescribing pathways to triple therapy in patients with chronic obstructive pulmonary disease in the United States.
Article in Therapeutic advances in respiratory disease. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- Methods to assess COPD medications adherence in healthcare databases: a systematic review.European respiratory review : an official journal of the European Respiratory Society · 2023Pooled it
- Treatment Patterns and Triple Therapy Utilization in Chinese Patients with Chronic Obstructive Pulmonary Disease: An Analysis of Real-World Data from the Yinzhou Database.International journal of chronic obstructive pulmonary disease · 2025Article
- An Italian Delphi Consensus on the Triple inhalation Therapy in Chronic Obstructive Pulmonary Disease.Multidisciplinary respiratory medicine · 2024Article
- Investigation of the Prevalence of Oral Mucositis and Associated Risk Factors in Chronic Obstructive Pulmonary Disease Patients: A Prospective Cross-Sectional Study.Thoracic research and practice · 2023Article
- Real-World Treatment Patterns and Switching Following Moderate/Severe Chronic Obstructive Pulmonary Disease Exacerbation in Patients with Commercial or Medicare Insurance in the United States.International journal of chronic obstructive pulmonary disease · 2023Article
- Treatment Transitions in Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases.Pulmonary therapy · 2022Article
- Beyond Dual Bronchodilation - Triple Therapy, When and Why.International journal of chronic obstructive pulmonary diseaseArticle
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGlobal Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend triple therapy (TT) for chronic obstructive pulmonary disease (COPD) patients based on severity. TT utilization by severity is infrequently studied in real-world settings and may deviate significantly from current clinical recommendations. This study describes prescribing pathways to TT among patients with COPD in the United States.
methodsThis study analyzed Geisinger Health System electronic medical records from 1 January 2004 to 30 November 2016. Two retrospective cohorts of COPD patients were included: (1) incident COPD, and (2) incident TT users. COPD treatment patterns, including time to TT, were summarized. Time to TT was estimated using Kaplan-Meier methods. Predictors of the relative hazard for TT among incident COPD patients were estimated using Cox proportional hazards regressions.
resultsIncident COPD and TT cohorts included 57,141 and 8173 patients, respectively. TT was used by 9.6% of incident COPD patients. In the year before TT, 34.3% of incident TT patients received treatment combinations recommended before TT according to GOLD recommendations, which mainly included: long-acting muscarinic antagonists (LAMAs), long-acting beta agonists (LABAs) + LAMAs, and inhaled corticosteroids + LABAs. Among incident TT patients, median time from COPD diagnosis to TT exceeded 2 years. The hazard for TT over time was associated with lower forced expiratory volume in 1 s values, more frequent exacerbations, current/previous smoking, and comorbid lung conditions such as pulmonary vascular disease, acute respiratory failure, and lung cancer. About 15-20% of the incident TT patients stepped down to a one- or two-drug regimen. Median time to TT discontinuation or step-down were 2 and 9 months, respectively.
conclusionThe study has revealed discrepancies in the treatment of COPD patients between GOLD guidelines and actual clinical practices in the United States. Pathways to TT differed from recommended therapy regimes. Further studies are needed to understand barriers to the use of guideline-recommended TTs by healthcare providers.
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