Clinical Concepts for Triple Therapy Use in Patients with COPD: A Delphi Consensus

Abstract

Purpose Role of triple therapy in chronic obstructive pulmonary disease (COPD) management is supported by growing evidence, but consensus is lacking on various aspects. We conducted a Delphi survey in respiratory experts on the effects of triple therapy on exacerbation reduction, early optimization, pneumonia risk, and mortality benefits in COPD management. Methods The study comprised 2-round online surveys and a participant meeting with 21 respiratory experts from 10 countries. The 31-statement questionnaire was prepared using Decipher software after literature review. Responses were recorded using Likert scale ranging from 1 (disagreement) to 9 (agreement) with a consensus threshold of 75%. Results All experts participated in both surveys and 14/21 attended participant meeting. Consensus was reached on 13/31 questions in first survey and 4/14 in second survey on: mortality benefits of triple therapy; comparable pneumonia risk between single inhaler triple therapy (SITT) and multiple inhaler triple therapy (81%); preference of SITT for patients with high eosinophil count (95%); exacerbation risk reduction and healthcare cost benefits with early initiation of SITT post exacerbation-related hospitalization (<30 days) (86%). No consensus was reached on first line SITT use after first exacerbation resulting in COPD diagnosis (62%). Conclusion This study demonstrated that there is consensus among experts regarding many of the key concepts about appropriate clinical use and benefits of triple therapy in COPD. More evidence is required for evaluating the benefits of early optimisation of triple therapy.

Delphi Consensus on Clinical Applications of GOLD 2023 Recommendations in COPD Management: How Aligned are Recommendations with Clinical Practice?

“…The DEPICT study demonstrated long-term benefits of early initiation of triple therapy at an earlier stage of the disease [ 21 ]. Further, triple therapy also reduces the risks of mortality and exacerbations [ 22 ].…”

“…Triple therapy should be given to patients with clinical indication, proper vaccination protocol and better control of comorbidities, thus preventing the development of other respiratory infections. Similarly, another Delphi study reported that in addition to ICS use, a patient with COPD was more likely to develop pneumonia if they had a history of smoking, diabetes, pneumonia, or exacerbations; older age, lower BMI, and severe airway obstruction [ 22 ].…”