To treat COPD, you may need to take a combination of several different medications. Some of these drugs relax your airways. Others bring down swelling in your lungs. The goal of taking more than one drug together is to help you breathe easier.
One way to deliver COPD drugs is through an inhaler. When you breathe into this L-shaped device, it delivers the medication straight into your lungs.
You can take each drug you need through separate inhalers. Or, you can take two or three drugs in a single inhaled dose.
Triple therapy combines three inhaled COPD drugs:
- a corticosteroid to bring down swelling in your airways
- a long-acting beta-agonist to relax the muscles around your airway
- an anticholinergic drug to widen the large airways
In the past, you’d take triple therapy in two separate inhalers. One inhaler contained an inhaled corticosteroid and a long-acting beta-agonist. The other contained an anticholinergic.
In 2017, the FDA approved Trelegy Ellipta, the first triple therapy in one inhaler. It combines:
- fluticasone furoate, a corticosteroid
- vilanterol, a long-acting beta-agonist
- umeclidinium, an anticholinergic
You take Trelegy Ellipta once a day by breathing in the powdered medication through the inhaler. This medication opens your airway, brings down swelling in your lungs, and helps you breathe easier for 24 hours.
Your doctor may put you on triple therapy if you’ve been on single or dual therapy and it hasn’t done enough to control your symptoms and prevent COPD flares.
Dual therapy for COPD combines two drugs into one inhaler. This treatment has been around since 2013.
Some dual therapies combine an anticholinergic drug with a long-acting beta-agonist:
- Anoro Ellipta (umeclidinium and vilanterol)
- Duaklir (aclidinium bromide and formoterol fumarate)
Another combines a long-acting beta-agonist with a corticosteroid:
- Breo Ellipta (fluticasone furoate and vilanterol)
Triple therapy seems to reduce the number of flares and improve quality of life in people with COPD better than dual therapy. But it may increase your risk of side effects.
Studies show that people who are on triple therapy have fewer COPD flares than those who are on dual therapy. They’re also less likely to be hospitalized for attacks of COPD symptoms.
Triple therapy in a single inhaler doesn’t work better than the same treatment given in three separate inhalers,
It’s also possible that combining three drugs that work in different ways might be more effective at treating COPD. But that hasn’t been proven yet.
Trelegy Ellipta is approved for people with COPD, including those with chronic bronchitis and emphysema. Your doctor may prescribe this drug if you’ve been taking dual therapy, but your symptoms haven’t improved enough. Trelegy Ellipta is not meant for people with asthma.
Dual therapies like Anoro Ellipta and Duaklir are approved for the maintenance treatment of COPD. Breo Ellipta is also approved to treat asthma in adults.
The most common side effects of triple therapy include:
- back pain
- a change in your sense of taste
- throat pain
- stomach flu
Other possible risks include:
- increased chance of getting pneumonia
- yeast infection of the mouth
- worsening of existing infections such as tuberculosis
- weakened bones
- glaucoma and cataract
Trelegy Ellipta, Anoro Ellipta, and Duaklir all contain boxed warnings about the increased risk of death from long-acting beta-agonists like vilanterol in people with asthma. These drugs are not recommended for people with asthma.
Your doctor might suggest that you go on triple therapy if the dual therapy inhaler you’ve been on hasn’t controlled your COPD symptoms well enough. Switching to triple therapy may work better at helping you avoid symptom flares.
Before you switch to a new treatment, ask your doctor what side effects it could cause. Find out if you’re at increased risk of these problems because of your health history or other medications you take. Ask how to manage any side effects you experience.