Single-inhaler tripleversusdual bronchodilator therapy for GOLD group E and other exacerbating patients with COPD: real-world comparative effectiveness and safety

In the most recent 2023 report, the GOLD committee recommends to no longer consider the degree of dyspnea when prescribing the very initial treatment of patients with chronic obstructive pulmonary disease (COPD) who have a history of exacerbations [1]. Thus, the former grades C and D are now regrouped into a single new “Group E” defined exclusively in terms of prior exacerbations, either two or more moderate ones or one severe leading to hospitalisation, in the previous year. The recommendation is to initiate treatment for these Group E patients directly with a combined long-acting muscarinic antagonist (LAMA) and long-acting beta2-agonist (LABA) inhaler (LAMA-LABA). However, for those Group E patients with blood eosinophil count ≥300 cells·μL−1, it recommends adding an inhaled corticosteroid (ICS), namely, to consider a triple LAMA-LABA-ICS inhaler. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: S. Suissa attended scientific advisory committee meetings or received speaking fees from AstraZeneca, Atara, Boehringer-Ingelheim, Bristol-Myers-Squibb, Merck, Novartis, Panalgo, Pfizer and Seqirus.