Real-World Long-Term Outcomes of Triple Therapy Following Hospitalization for Acute Exacerbation of COPD: A...

Chronic obstructive pulmonary disease (COPD) exacerbations significantly accelerate disease progression and increase mortality and healthcare utilization. While triple therapy (inhaled corticosteroids/long-acting β₂-agonist/long-acting muscarinic antagonist [ICS/LABA/LAMA]) is commonly prescribed to manage COPD, its long-term real-world effectiveness following hospitalization for acute exacerbation of COPD remains unclear.

This retrospective cohort study included 500 patients hospitalized for severe COPD exacerbations at a tertiary hospital (2015-2023). Patients were classified as receiving triple therapy (ICS/LABA/LAMA) during or within 7 days after the index hospitalization or not. Primary outcomes were COPD-related readmission and all-cause mortality within three years; secondary analyses were stratified by prior exacerbation frequency, baseline FEV₁ % predicted, and eosinophil count. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models, with Kaplan-Meier methods for survival.

Among the study population, 329 patients (65.8%) received triple therapy. Overall, no significant differences were observed in three-year COPD-related readmission rates (adjusted hazard ratio [aHR]: 0.95, 95% confidence interval [CI]: 0.66-1.35) or all-cause mortality (aHR: 0.88, 95% CI: 0.57-1.36) between the groups. However, stratified analyses demonstrated significant benefits of triple therapy in patients with ≥2 exacerbations within one year prior to the index hospitalization (aHR for readmission: 0.14; aHR for mortality: 0.24) and showed numerically lower risks among those with baseline FEV₁ ≥50% predicted (aHR for readmission: 0.57; aHR for mortality: 0.43).

Triple therapy was not associated with improved outcomes in the overall cohort but may be associated with better outcomes in selected high-risk subgroups. These findings should be interpreted with caution given the observational design and potential residual confounding. Further studies are warranted to confirm these findings and refine patient selection for triple therapy.