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Risk of Hospitalized COVID-19 in COPD: Single-Inhaler Triple Versus Dual Bronchodilator Therapy
Simon Galmiche1,2, Sophie Dell'Aniello1, Samy Suissa1,2
1Center for Clinical Epidemiology, Lady Davis Institute (LDI), Jewish General Hospital, Montreal, Canada.
Pharmacoepidemiology and Drug Safety
|January 4, 2026
Summary
Patients with COPD using triple inhalers (inhaled corticosteroids, long-acting beta-agonists, long-acting muscarinic antagonists) faced a higher risk of severe COVID-19 before vaccines. This highlights potential risks of certain COPD treatments.
Area of Science:
- Respiratory Medicine
- Infectious Disease Epidemiology
Background:
- Chronic Obstructive Pulmonary Disease (COPD) management often involves inhaled therapies.
- The COVID-19 pandemic raised concerns about the impact of pre-existing respiratory conditions and their treatments on disease severity.
Purpose of the Study:
- To compare the risk of severe COVID-19 in COPD patients initiating single-inhaler triple therapy (inhaled corticosteroids-long-acting beta-agonist-long-acting muscarinic antagonist) versus dual bronchodilator therapy (long-acting beta-agonist-long-acting muscarinic antagonist).
- To assess this risk in the pre-vaccine era.
Main Methods:
- A UK-based cohort study emulating a randomized trial was conducted.
- Propensity score weighting was used to adjust for confounders in patients aged 40+ with COPD.
- The primary outcome was hospitalized COVID-19, analyzed using a Cox proportional hazards model.
Main Results:
- The study included 876 patients on triple therapy and 5010 on dual therapy.
- An increased risk of hospitalized COVID-19 was observed in the triple inhaler group (HR: 1.96; 95% CI: 1.01-3.77).
- Sensitivity analyses supported the main findings.
Conclusions:
- Initiating inhaled corticosteroids-containing triple therapy in COPD patients was associated with a potentially increased risk of severe COVID-19 before widespread vaccination.
- These findings are crucial for clinical decision-making regarding COPD treatment initiation, especially with ongoing SARS-CoV-2 circulation.
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