Profiling High-risk Chronic Obstructive Pulmonary Disease Patients for Triple Therapy: Who Needs It Most?

Chronic obstructive pulmonary disease (COPD) remains a major contributor to global morbidity and mortality, carrying a substantial clinical and socioeconomic burden. Comprehensive identification of clinical characteristics, biomarkers, and treatment requirements is essential to guide optimal therapeutic strategies. This study aimed to evaluate the clinical determinants associated with the need for triple therapy in COPD patients.

An analytical observational study with a cross-sectional design was conducted at the Pulmonary Clinic of Universitas Airlangga Hospital. Eligible participants were male patients aged ≥40 years who underwent spirometry and complete clinical evaluation. Patients with incomplete records or concomitant lung diseases were excluded. Clinical data, spirometry, and laboratory results were analyzed using SPSS, with P < 0.05 considered statistically significant.

A total of 50 patients were included. Most were ≥60 years (64%) and severe smokers (74%) with a mean Brinkman index of 827. The majority presented moderate symptom burden according to St. George's Respiratory Questionnaire (SGRQ) (82%), moderate-to-severe functional limitation based on 6-min walk test (60%), and high exacerbation risk (46%). Significant factors associated with the need for triple therapy included blood eosinophil levels (P < 0.001), exacerbation severity (P = 0.001), impaired quality of life (SGRQ, COPD Assessment Test), comorbidity of myocardial infarction, and classification within the Airflow limitation, Burden of symptoms, and Exacerbation risk (ABE) Group.

Triple therapy was predominantly required in patients with eosinophil counts ≥300 cells/μL, a history of severe exacerbations, and those classified as Group E in the ABE group. These patients exhibited poorer quality of life and higher comorbidity burden. The findings align with the WISDOM Trial, underscoring the importance of multidimensional assessment in guiding individualized COPD management.