5 1.5 Future Direction of Triple Therapy

Where do we go from here?

This study was the first to demonstrate that triple therapy using a combination of an ICS, a LABA, and a LAMA are more effective in the treatment of ACO than dual therapy using a combination of an ICS and LABA alone.

However, although the researchers were able to show that triple therapy was more effective than dual therapy, they were only able to speculate the underlying reasons as to why. The precise mechanisms behind this beneficial effect still remain undiscovered and should be explored in further studies.

Now that it is known that using a combination of an ICS, a LABA, and a LAMA is an effective method of treating ACO, further studies should focus on which particular combination of drugs is the most effective. This study showed that a combination of umeclidinium, fluticasone, and vilanterol was an effective combination, but further studies should explore other combinations of drugs as this may not be the most effective combination. Additionally, the different subtypes of patients with ACO may benefit from different treatment combinations.

As this was a pilot study, they used both a small sample size and short treatment duration to test the effectiveness of triple therapy. Longer and larger studies in the future may be able to reveal beneficial effects that translate into clinical significant differences, as this study was only able to show statistically significant differences in lung function and was unable to show changes in the patients’ subjective system experiences as measured by their CAT and ACT scores.

Future studies should include a diverse sample so that the results can be extrapolated to a more diverse population as this study focused on a very specific sample of older Japanese participants who were ex-smokers. Future studies should include both male and female participants as well as participants from multiple different ethnicities and health backgrounds.