title: Advances in drug delivery: Is triple therapy the future for the treatment of chronic obstructive pulmonary disease?
abstract: BACKGROUND
  Current therapies for chronic obstructive pulmonary disease (COPD) focus on the improvement of clinical symptoms via the use of bronchodilators: β(2)-adrenoreceptor agonists and muscarinic (M3) acetylcholine receptor antagonists. The combination of inhaled corticosteroids (ICSs) and long-acting β(2) agonists (LABAs), or LABAs and anticholinergics has become an efficient alternative to single therapies. These combinations consist of a LABA and an ICS together with an anticholinergic, such as ipratropium or tiotropium.
  
  
  METHODS
  This review summarizes the latest thinking and findings on the usefulness of triple therapy in the treatment and management of COPD. Drawing on commercial, clinical, scientific and intellectual property data and publications, it aims to provide an overview to understand the efficacy and need for COPD triple therapy. The reader will gain an in-depth view of the triple therapy approach in managing COPD, existing molecules in the market or in development as well as new chemical entities. Clinical evidence in support of triple therapy, formulations and products are also discussed.
  
  
  CONCLUSIONS
  There is limited documented clinical evidence for the use of triple therapy in COPD, reflected in the lack of commercial activity in the field. The future for the management of COPD may lie with triple therapy, but may equally rest on a better understanding of the disease and subsequent development of new chemical entities, such as dimer molecules, longer-acting β-agonists and antimuscarinics.
authors.affiliation: Faculty of Pharmacy, Advanced Drug Delivery Group, The University of Sydney, Sydney, NSW 2006, Australia.
authors.forename: Rania O
authors.initials: RO
authors.lastname: Salama
authors.forename: Paul M
authors.initials: PM
authors.lastname: Young
authors.forename: Philippe
authors.initials: P
authors.lastname: Rogueda
authors.forename: Arthur
authors.initials: A
authors.lastname: Lallement
authors.forename: Ilian
authors.initials: I
authors.lastname: Iliev
authors.forename: Daniela
authors.initials: D
authors.lastname: Traini
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000627:therapeutic use; D004338:Drug Combinations; D016503:Drug Delivery Systems / Q000639:trends; D015507:Drugs, Investigational / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D018973:Intellectual Property; D058988:Phosphodiesterase 4 Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D003692:Delayed-Action Preparations; D004338:Drug Combinations; D015507:Drugs, Investigational; D058988:Phosphodiesterase 4 Inhibitors