Single inhaler extra fine triple therapy versus open triple therapy in COPD: TRIPOLI observational study

<bold>Introduction:</bold> Triple therapy is common in chronic obstructive pulmonary disease (COPD) patients. In Spain, evidence of the benefits of switching from triple therapy administered in several devices to a single device in a routine clinical practice setting is scarce. <bold>Material and Methods:</bold> Single-centre retrospective study in patients with COPD and triple maintenance therapy using one or several devices in a real-life setting. The primary endpoint was the variation in the moderate and severe exacerbations over one year with fixed-dose extra fine triple therapy of beclomethasone, formoterol, and glycopyrronium in a single inhaler (Trimbow ©) versus any combination of open-label triple therapy. Other variables analysed were moderate exacerbations, severe exacerbations, use of rescue therapy, and adherence. <bold>Results:</bold> Between May and July 2021, we analyzed 74 subjects, of which 78.4% were male, with a mean age of 72.7 (standard deviation-DE 8.9) years and 97.3% (72) were ex-smokers. In the total cohort, extra fine triple therapy reduced the annual rate of moderate and severe exacerbations and moderate exacerbations by 19.0% (p = 0.006 Wilcoxon test) and 21.2% (p=0.001), respectively, compared to multi-device triple therapy. Among the 78.4% of the patients who did not receive extra fine particle in the first year, the fixed-dose combination reduced the rate of moderate exacerbations by 16.0% (p = 0.036). <bold>Conclusions:</bold> Extra fine triple therapy delivered in a single inhaler in COPD patients decreases moderate and severe exacerbations, in addition to other clinical benefits, compared to using triple therapy in multiple devices in a routine clinical practice setting.