Volume : 13, Issue : 06, June – 2026

Title:

SINGLE-INHALER TRIPLE THERAPY IN COPD: INTEGRATING CLINICAL EFFICACY, DEVICE ERGONOMICS, AND COGNITIVE FACTORS FOR TREATMENT SUCCESS – A COMPREHENSIVE REVIEW

Authors :

Honey Mariya Babu, Dr. Tamilselvan, Mrs. Vineetha S, Asika Dileep, Betty George, Jismi Jackson, Kadeejathul Hana KP

Abstract :

COPD remains a major cause of morbidity and mortality worldwide. Early optimization of bronchodilation in conjunction with anti-inflammatory medication has become more important in the management of moderate-to-severe illness. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, patients with persistent symptoms and/or frequent exacerbations despite dual maintenance therapy are advised to use single-inhaler triple therapy (SITT), which combines a long-acting beta2-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS).
In addition to device-related performance features and cognitive factors influencing inhaler use, this thorough analysis summarizes data from significant randomized controlled trials and real-world investigations assessing the therapeutic efficacy of SITT. When compared to dual treatments, SITT consistently improves lung function and lowers rates of moderate-to-severe exacerbations across pivotal trials. However, real-world effectiveness is heavily influenced by device selection, inspiratory flow capacity, and patient-level cognitive and behavioural factors that affect inhaler technique.
Although mortality reductions have been reported in secondary analyses, these findings remain exploratory and require prospective confirmation. In general, combining pharmaceutical efficacy with customized device and cognitive evaluation is essential for therapeutic success.
Keywords: COPD; single-inhaler triple therapy; inhaler technique; device ergonomics; cognitive impairment; exacerbation prevention.

Cite This Article:

Please cite this article in press Honey Mariya Babu et al., Single-Inhaler Triple Therapy In Copd: Integrating Clinical Efficacy, Device Ergonomics, And Cognitive Factors For Treatment Success – A Comprehensive Review, Indo Am. J. P. Sci, 2026; 13(06).

REFERENCES:

1. Lipson DA, Barnhart F, Brealey N, et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med. 2018;378(18):1671–1680.
2. Ferguson GT, Rabe KF, Martinez FJ, et al. Triple therapy with budesonide/glycopyrrolate/formoterol fumarate versus dual therapies in COPD (KRONOS). Lancet Respir Med. 2018;6(10):747–758.
3. Singh D, Bafadhel M, Arya N, et al. Post-hoc analyses of KRONOS in COPD patients on ICS/LABA therapy. Int J Chron Obstruct Pulmon Dis. 2020; 15:1119–1130.
4. Singh D, Papi A, Corradi M, et al. Triple therapy versus ICS/LABA in COPD (TRILOGY trial). Lancet. 2016;388(10048):963–973.
5. Adisa R, Ufuah FU, Ige OM. Pharmacist-led intervention in inhaler use and COPD control. J Pharm Policy Pract. 2020; 13:43.
6. Lipson DA, Crim C, Criner GJ, et al. Reduction in all-cause mortality with FF/UMEC/VI in COPD. Am J Respir Crit Care Med. 2020;201(12):1508–1516.
7. Papi A, Vestbo J, Fabbri LM, et al. Cost-effectiveness of single-inhaler triple therapy in COPD. Int J Chron Obstruct Pulmon Dis. 2021; 16:1321–1332.
8. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2025 Report. Available from: https://goldcopd.org. Accessed June 16, 2026.
9. Bansal S, Anderson M, Anzueto A, et al. FF/UMEC/VI triple therapy versus monotherapy in COPD. Adv Ther. 2019;36(11):3265–3279.
10. Neunhäuserer D, Reich B, Mayr B, et al. Exercise training and COPD functional outcomes. Sports Med Open. 2020; 6:45.
11. Chuatrakoon B, Uthaikhup S, Ngai SP, et al. Home-based pulmonary rehabilitation in COPD. J Clin Med. 2022;11(13):3642.
12. Van der Palen J, Thomas M, Chrystyn H, et al. Inhaler errors and device comparison study (ELLIPTA). NPJ Prim Care Respir Med. 2016; 26:16079.
13. Papi A, Vestbo J, Fabbri LM, et al. Extra fine triple therapy versus dual therapy (TRIBUTE). Lancet. 2018;391(10125):1076–1084.
14. Ferguson GT, Boe A, Hill TD, et al. Digital inhaler monitoring in COPD. Int J Chron Obstruct Pulmon Dis. 2021; 16:3125–3135.
15. Azouz W, Chetcuti P, Hosker H, et al. Inhalation characteristics of DPI vs pMDI devices. BMC Pulm Med. 2015; 15:62.
16. Hanania NA, Sethi S, Koltun A, et al. Long-term safety of formoterol inhalation solution in COPD. Ther Adv Respir Dis. 2019; 13:1753466619856554.
17. Antonelli Incalzi R, Corsonello A, Trojano L, et al. Cognitive impairment in COPD. Eur J Phys Rehabil Med. 2015;51(4):451–461.
18. Patel M, Marshall J, Martinez FJ, et al. Productive cough and exacerbation risk in COPD. Respir Res. 2021; 22:114.
19. Al-Showair RAM, Tarsin WY, Assi KH, et al. Inhalation flow capability in COPD patients. Respir Med. 2007;101(11):2395–2401.
20. Jensen D, Amjadi K, Harris-McAllister V, et al. Mechanisms of dyspnea in COPD. Thorax. 2008;63(7):606–613.
21. Prime D, de Backer W, Hamilton M, et al. Inspiratory profiles through DPI devices. J Aerosol Med Pulm Drug Deliv. 2015;28(4):273–281.
22. Broeders MEAC, Molema J, Hop WCJ, et al. Inhalation profiles during COPD exacerbations. Respir Med. 2004;98(12):1173–1179.
23. Lindh A, Theander K, Arne M, et al. Educational intervention in inhaler technique. Prim Care Respir J. 2013;22(3):294–299.
24. Martinez FJ, Rabe KF, Ferguson GT, et al. Symptom outcomes in ETHOS trial. Respir Res. 2021; 22:201.
25. Rabe KF, Martinez FJ, Singh D, et al. Lung function outcomes in ETHOS trial. Lancet Respir Med. 2021;9(8):831–842.
26. Ahn JH, Chung JH, Shin KC, et al. Repeated inhaler education in COPD. J Thorac Dis. 2020;12(11):6512–6526.
27. Quinet P, Young CA, Héritier F. DPI use in elderly COPD patients. Rev Mal Respir. 2003;20(4):531–537.
28. Yang IA, Clarke MS, Sim EHA, et al. ICS therapy in COPD: systematic review. Cochrane Database Syst Rev. 2012;7.