TY - JOUR T1 - Triple therapy for all patients with severe symptomatic COPD at risk of exacerbations JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00147-2019 VL - 53 IS - 4 SP - 1900147 AU - Alberto Papi AU - Stefano Petruzzelli AU - Stefano Vezzoli AU - George Georges AU - Leonardo M. Fabbri Y1 - 2019/04/01 UR - http://erj.ersjournals.com/content/53/4/1900147.abstract N2 - Suissa and Ariel [1] performed a post hoc analysis of TRIBUTE and IMPACT [2, 3], by “digitising” the figures to obtain values over each month of the cumulative incidence curves. They concluded that the lower rate of a first exacerbation with triple long-acting muscarinic antagonist/long-acting β2-agonist/inhaled corticosteroid (LAMA/LABA/ICS) therapy was exclusively due to a lower rate in the first month of treatment, while the rates were comparable to LAMA/LABA in the subsequent 11 months. They argue that this pattern of “depletion of susceptible individuals” might identify a small group of patients and suggest that only these patients could benefit from triple therapy, whereas the majority could be treated with LAMA/LABA without risk. They also found that the 42% lower mortality with triple therapy in IMPACT was localised in the first 4 months of follow-up, with no difference in the following 8 months. Based on these observations, they speculate that the subgroup who may benefit from triple therapy could be represented by patients with a history of asthma or eosinophilia, and they could be identified a priori.In keeping with the latest international recommendations, we suggest using triple therapy in all patients with severe symptomatic COPD at increased risk of exacerbation who are not adequately treated by LAMA/LABA or LABA/ICS, independent of asthma history http://ow.ly/Bbsr30nXffOWriting support was provided by David Young (Young Medical Communications and Consulting Ltd, Horsham, UK). This support was funded by Chiesi Farmaceutici SpA. ER -