Triple Therapy for COPD

A new triple therapy inhaler is available for the maintenance treatment of chronic obstructive pulmonary disease (COPD). Trimbow® contains the inhaled corticosteroid (ICS), beclometasone, the long-acting beta₂ agonist (LABA), formoterol, and the long-acting muscarinic antagonist (LAMA), glycopyrronium.

The efficacy of this combination in a single inhaler was compared to beclometasone plus formoterol in a large double-blind trial. Patients randomised to receive triple therapy demonstrated a 23% reduction in exacerbations compared to dual therapy.

Trimbow® is now available on the PBS as a streamlined authority item. The clinical criteria is for patients who have experienced at least one severe exacerbation, or multiple moderate exacerbations, of COPD in the previous 12 months despite regular bronchodilator therapy. Patients must also have been stabilised on a combination of a LAMA, LABA, and an ICS.

The Trimbow® inhaler must be refrigerated prior to dispensing to the patient. However, patients may keep the inhaler below 30°C for up to two months. Patients should be advised to rinse their mouth after use to reduce the risk of oropharyngeal candida infections.