Research Article | Volume: 10, Issue: 10, October, 2020

Three-drug therapy versus two-drug therapy for management of patient-reported manifestations and quality of life in chronic obstructive pulmonary disease patients: A meta-analysis

Ganesh Narayan Sharma Syed Aamir Ali Birendra Shrivastav Aleemuddin Naveed Mohd   

Open Access   

Published:  Oct 05, 2020

DOI: 10.7324/JAPS.2020.10104

Patient-reported manifestations and quality of life (QoL) data for chronic obstructive pulmonary disease (COPD) drugs are sparse. This study compared three-drug therapy comprising inhaled corticosteroids (ICS), long-acting beta2 agonists (LABA), and long-acting muscarinic antagonists (LAMA) with two-drug therapy (ICS/LABA or LABA/ LAMA) in terms of patient-reported manifestations and QoL. Randomized controlled trials (RCTs) comparing three-drug therapy with two-drug therapy in COPD patients were searched through Pubmed and meta-analyzed. Efficacy endpoints included St George Respiratory Questionnaire (SGRQ) score, SGRQ responders, COPD assessment test (CAT) score, rescue drug use, rescue drug-free days, and adverse events resulting in drug cessation. Three-drug therapy showed improvement in SGRQ scores [mean difference (MD), −1.66; 95% confidence interval (CI), −2.09 to −1.23] and SGRQ responders [Odds Ratio (OR), 1.30; 95% CI, 1.18–1.44] compared to ICS/LABA dual therapy; and SGRQ scores (MD, −1.65; 95%CI, −2.31 to −0.99) and SGRQ responders (OR, 1.20; 95%CI, 1.08–1.34) compared to LABA/ LAMA dual therapy. Similarly, results with CAT scores, rescue medication use, percentage of rescue medication-free days, and adverse events resulting in drug cessation favored the three-drug therapy compared to the two-drug therapy. Three-drug therapy had improved SGRQ scores, CAT scores, reduced rescue medication use, and better QoL.

Keyword:     COPD assessment test (CAT) adverse events St George Respiratory Questionnaire (SGRQ) meta-analysis rescue medication use.


Sharma GN, Ali SA, Shrivastav B, Mohd AN. Three-drug therapy versus two-drug therapy for management of patient-reported manifestations and quality of life in chronic obstructive pulmonary disease patients: A meta-analysis. J Appl Pharm Sci, 2020; 10(10):036-049.

Copyright: © The Author(s). This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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