Triple therapy (ICS/LABA/LAMA) in COPD: thinking out of the box

Schematic overview of the suggested pharmacological management of chronic obstructive pulmonary disease (COPD). We suggest an initial treatment for the patient as a function of the first presentation and correct COPD diagnosis. The majority of patients will not receive triple therapy at first presentation, but depending their natural history might end up escalating to triple therapy. Patients who present for the first time with hospitalisation or high symptoms and high exacerbation risk could be considered for triple therapy, which is then re-evaluated during follow up. LAMA: long-acting muscarinic antagonist; LABA: long-acting β₂-agonist; ICS: inhaled corticosteroid.