Single-Inhaler Triple versus Dual Therapy in Patients with COPD

In the randomized Informing the Pathway of COPD Treatment (IMPACT) trial involving more than 10,000 patients with chronic obstructive pulmonary disease (COPD), Lipson and colleagues (May 3 issue) compared a once- daily combination of f luticasone furoate (an inhaled glucocorticoid), umeclidinium (a long- acting muscarinic antagonist [LAMA]), and vilanterol (a long-acting β2-agonist [LABA]) with an inhaled glucocorticoid–LABA or a LABA–LAMA combination. The primary outcome was the annual rate of moderate or severe COPD exacer- bations. Since a large fraction of COPD exacerba- tions are infectious in origin, we wonder whether there were any differences among the three groups with respect to the proportion of patients who had received annual inf luenza and pneumococcal vaccinations. A meta-analysis of two randomized trials in- volving patients with COPD showed that sea- sonal influenza vaccine had significantly better efficacy in preventing exacerbations than place- bo. In addition, in a recently updated Cochrane meta-analysis, pneumococcal vaccination was as- sociated with significant efficacy not only against community-acquired pneumonia but also in the prevention of acute exacerbations in patients with COPD.