Abstract
Objectives: The objectives of the study were to estimate the relative impact of triple therapy on lung function, health status, and mortality risk compared with combination inhaled corticosteroid (ICS)/long-acting β-agonist (LABA) therapy in symptomatic chronic obstructive pulmonary disease (COPD) patients with frequent exacerbations in an Indian clinical population.
 Methodology: The GLIMPSE (Lung Function, Health Status, and Mortality Risk Assessment in COPD using Triple Therapy) was as a prospective, parallel design, single-center observational study comparing 24 weeks of triple therapy (twice-daily combination of budesonide [BUD]-formoterol [FOR] [100/6 μg] and once-daily tiotropium [TIO] [9 μg]) with ICS/LABA (twice daily BUD-FOR [100/6 μg]). The primary outcome was the mean change in forced expiratory volume in the 1st s (FEV1%) predicted and COPD assessment test total score from baseline at week 24. Secondary outcomes were variation in dyspnea grade and BODE total score from baseline.
 Results: At week 24 in triple therapy (n=70) and ICS/LABA therapy (n=70), mean difference from baseline in FEV1% predicted were 5.40 (95% confidence interval [CI]: 1.29–9.50) and 1.90 (95% CI: –1.87–5.68) respectively, and mean difference in CAT total score from baseline was –5.10 units (95% CI: –3.49–−6.71) and –1.80 units (95% CI: –0.052–−3.548), respectively. In addition, there was a statistically significant reduction in dyspnea grading and BODE score with comparable adverse events in both groups.
 Conclusion: Overall, the results favored triple therapy over dual therapy in advanced symptomatic COPD patients.
Highlights
The global initiative for chronic obstructive lung disease (GOLD) management approach at present suggests the use of triple therapy in advanced chronic obstructive pulmonary disease (COPD) patients with chronic symptoms and at increased possibility of exacerbation despite maximal dual bronchodilation or glucocorticoid-LABA
The lung function, health status, and mortality risk assessment in COPD using triple therapy (GLIMPSE) study is the first study in an Indian clinical setting to compare multiple inhaler triple therapy (ICS/LAMA/LABA) with dual therapy (ICS/LABA) in advanced, symptomatic COPD patients at a higher risk of exacerbations
Patients were divided into those receiving triple therapy and dual therapy, with 70 patients in each group
Summary
The global initiative for chronic obstructive lung disease (GOLD) management approach at present suggests the use of triple therapy (combination inhaled corticosteroid [ICS]+long-acting β-agonist [LABA]+long-acting muscarinic antagonist [LAMA]) in advanced chronic obstructive pulmonary disease (COPD) patients with chronic symptoms and at increased possibility of exacerbation despite maximal dual bronchodilation or glucocorticoid-LABA. Triple therapy may provide a greater enhancement in lung function and health status compared with ICS/LABA dual therapy [1,2,3,4]. The lung function, health status, and mortality risk assessment in COPD using triple therapy (GLIMPSE) study is the first study in an Indian clinical setting to compare multiple inhaler triple therapy (ICS/LAMA/LABA) with dual therapy (ICS/LABA) in advanced, symptomatic COPD patients at a higher risk of exacerbations. We used the same agents and same doses in dual therapy as well as triple therapy
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