PCRS Position Statement - Triple therapy in COPD (Updated June 2026)
Triple therapy for patients with COPD refers to the combination of long-acting muscarinic antagonists (LAMA), long- acting beta2 agonists (LABA) and inhaled corticosteroids (ICS). Given the small but increased risk of pneumonia for patients prescribed ICS, it is essential that such treatment is only prescribed for patients likely to derive a clinical benefit.
The Primary Care Respiratory Society (PCRS) advocates a pragmatic approach to the pharmacological management of patients with chronic obstructive pulmonary disease (COPD) guided by the predominance of breathlessness and/or exacerbations and the presence or absence of comorbid asthma. Clinicians must undertake a holistic evaluation for alternative causes of persistent daily symptoms or repeated exacerbations and consider seeking advice from a respiratory specialist before escalating to triple therapy.1 The inhaled corticosteroid element of triple therapy should be withdrawn if there is no benefit to symptoms or frequency of exacerbations after a 3–6-month trial or the patient develops severe or recurrent pneumonia or mycobacterial infection whilst on treatment.
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