NEW YORK (Reuters Health) – For patients with chronic obstructive pulmonary disease (COPD), the combination of budesonide/formoterol with tiotropium is more effective than tiotropium alone.

The triple therapy improves lung function, controls symptoms, and reduces severe exacerbations, according to new research published October 15 in the American Journal of Respiratory and Critical Care Medicine.

Dr. Tobias Welte, from Hannover Medical School, Germany, and co-authors evaluated the efficacy and tolerability of combination treatment with the inhaled corticosteroid, long-acting beta-2 agonist, and long-acting muscarinic antagonist in a randomized, double-blind trial at 102 centers in nine countries.

The 660 subjects, all aged 40 and older, had pre-bronchodilator FEV1 not exceeding 50% of predicted normal value and a history of COPD exacerbations requiring systemic steroids and/or antibiotics.

Two to four weeks prior to the study, patients discontinued their beta agonist and corticosteroid medications. During a 2-week run-in, all of them used tiotropium 18 mcg once daily plus reliever medication (terbutaline 0.5 mg/inhalation) as needed.

At the start of the 12-week trial, patients were assigned to treatment with either budesonide/formoterol (320/9 mcg per inhalation), one inhalation twice daily, or placebo. Throughout the study, they continued to take tiotropium, along with reliever medication as necessary.