Do we need three players in copd treatment?

摘要

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that represents the third leading cause of death and disease burden worldwide. By definition, it is treatable, but the effectiveness of the current treatment is unsatisfactory since it results in little changes in the natural history of the disease [ 1 ]. Drugs for stable COPD reduce the symptoms, frequency, and severity of exacerbations and improve the quality of life and exercise tolerance, but none of them consistently attenuate the progressive decline in FEV_1. The positive effects on FEV_1 decline obtained with an inhaled corticosteroid/ long-acting Beta_2-agonist (ICS/LABA) combination or tio-tropium (Tio) have been demonstrated only in post hoc analysis or subanalysis of the TORCH and UPLIFT studies [2, 3]. Furthermore, few data have been reported on the ability of the current drugs to modify biomarkers of remodeling in COPD patients [4, 5]. Triple combination therapy with anticholinergics, ICS, and LABA improved pulmonary function and symptoms in COPD patients [6], but the mechanism behind the increased efficacy has not been studied.