Comparison of dyspnea score (mMrc) in patients with chronic obstructive pulmonary disease (COPD) using triple versus dual therapy
DOI:
https://doi.org/10.59736/IJP.24.03.1117Keywords:
COPD, Triple therapy, ExacerbationAbstract
Background: COPD is associated with long-term dyspnea and exacerbations. This research compared effects of using dual (LABA/LAMA) and triple (LABA/LAMA/ICS) inhaler therapy on dyspnea and exacerbations in COPD patients.
Methods: It was a comparative cohort study that was carried out by the Department of Pulmonology, Khyber Teaching Hospital, Peshawar, from January to June 2026. Consecutive sampling (non-probability) was conducted to enroll 336 COPD patients, although 168 cases took dual and 168 cases took triple therapy. Dyspnea was measured with modified Medical Research Council (mMRC) at baseline and follow up. Exacerbations were noted also. The SPSS version 26 was used in analysis of data through the use of parametric and non-parametric tests and multivariate logistic regression.
Results: Follow-up mMRC scores were lower with triple therapy than dual therapy (1.54 ± 0.94 vs. 2.18 ± 1.02; p<0.001). Mean mMRC improvement was greater with triple therapy (1.31 ± 0.76 vs. 0.64 ± 0.72; p<0.001). There was an improvement in clinical condition of 81.0% compared to 54.8% of the patients (p<0.001). Total exacerbations were also lower with triple therapy (3.2 ± 1.9 vs. 4.4 ± 2.3; p<0.001). Multivariate analysis revealed that triple therapy was still significantly correlated with the clinical improvement (AOR 3.42, 95% CI: 2.10-5.58; p<0.001).
Conclusion: Triple therapy has been linked to higher improvement of dyspnea and reduce exacerbation compared to dual therapy.
References
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2025 report. Fontana (WI): GOLD; 2025. https://goldcopd.org
O'Donnell DE, Milne KM, James MD, de Torres JP, Neder JA. Dyspnea in COPD: newmechanistic insights and management implications. Adv Ther. 2020;37(1):41-60. doi:10.1007/s12325-019-01128-9
Global Burden of Disease Chronic Respiratory Disease Collaborators. Global, regional, and national burden of chronic respiratory diseases and risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet RespirMed.2024;12(2):134-56. doi:10.1016/S2213-2600(23)00353-7
Haynes JM, Kaminsky DA, Ruppel GL. The role of pulmonary function testing in the diagnosis and management of COPD. RespirCare.2023;68(7):889-913. doi:10.4187/respcare.10688
Yorke J, Khan N, Garrow A, Tyson S, Singh D, Vestbo J, et al. Evaluation of the individual activity descriptors of the mMRC breathlessness scale: a mixed-method study. Int J Chron Obstruct PulmonDis.2022;17:2289-99. doi:10.2147/COPD.S374092
Ertan Yazar E, Niksarlioglu EY, Yigitbas B, Bayraktaroglu M. How to utilize CAT and mMRC scores to assess symptom status of patients with COPD in clinical practice? MedeniMedJ.2022;37(2):173-9.
doi: 10.4274/MMJ.galenos.2022.68412
HeoYA.Budesonide/glycopyrronium/formoterol: a review in COPD. Drugs. 2021;81(12):1411-22.
doi:10.1007/s40265-021-01575-y
Strange C, Tkacz J, Schinkel J, Lewing B, Agatep B, Swisher S, et al. Exacerbations and real-world outcomes after single-inhalertripletherapyofbudesonide/glycopyrronium/formoterol fumarate among patients with COPD: results from the EROS study. Int J Chron Obstruct Pulmon Dis.2023;18:2245-56. doi:10.2147/COPD.S423531
Ferguson GT, Rabe KF, Martinez FJ, Fabbri LM, Wang C, Ichinose M, et al. Triple therapywithbudesonide/glycopyrronium/formoterol fumarate versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a phase 3 randomized controlled trial. Lancet Respir Med.2018;6(10):747-58. doi:10.1016/S2213-2600(18)30327-8
Martinez FJ, Rabe KF, Ferguson GT, Wedzicha JA, Singh D, Wang C, et al. Reduced all-cause mortality in the ETHOS trialofbudesonide/glycopyrronium/formoterol for chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2021;203(5):53-564. doi:10.1164/rccm.202006-2618OC
Rabe KF, Martinez FJ, Ferguson GT, Wang C, Singh D, Wedzicha JA, et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe chronic obstructive pulmonary disease. N Engl J Med.2020;383(1):35-48. doi:10.1056/NEJMoa1916046
Lipson DA, Barnhart F, Brealey N, Brooks J, Criner GJ, Day NC, et al. Once-daily single-inhaler triple versus dual therapy in patients with chronic obstructive pulmonary disease (IMPACT). N Engl J Med.2018;378(18):1671-80. doi:10.1056/NEJMoa1713901
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