Outcome of inhaler withdrawal in patients receiving triple therapy for COPD

Sae Ahm Kim, Ji Hyun Lee, Eun Kyung Kim, Tae Hyung Kim, Woo Jin Kim, Jin Hwa Lee, Ho Il Yoon, Seunghee Baek, Jae Seung Lee, Yeon Mok Oh, Sang Do Lee

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting β2-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. Methods: Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the step-down group and as 1 year after the start of triple therapy in the triple group. Results: Lung function at the index time was superior and the previous exacerbation frequency was lower in the step-down group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second (FEV1) decline (54.7±15.7 mL/yr vs. 10.7±7.1 mL/yr, p=0.007), but there was no observed increase in the frequency of exacerbations. Conclusion: Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating FEV1 decline.

Original languageEnglish
Pages (from-to)22-30
Number of pages9
JournalTuberculosis and Respiratory Diseases
Issue number1
StatePublished - Jan 2016

Bibliographical note

Publisher Copyright:
Copyright © 2016 The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.


  • Chronic obstructive
  • Pulmonary disease


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