Chronic obstructive pulmonary disease (COPD) is a major cause of breathlessness, hospitalizations, and reduced quality of life worldwide.
Related condition guide: COPD

Inhaled medications, including bronchodilators and inhaled corticosteroids (ICS), are the cornerstone of COPD pharmacologic therapy. In 2024 to 2025, updates to the GOLD (Global Initiative for Chronic Obstructive Lung Disease) strategy documents refined when to step up to triple therapy:

LAMA (long-acting muscarinic antagonist) + LABA (long-acting beta-agonist) + ICS (inhaled corticosteroid).

This article explains who benefits from triple therapy, how GOLD 2024 to 2025 guides choices, and where medication personalization can help.
Support resources: Help Hub

The GOLD 2024 to 2025 Approach: ABE Groups and Exacerbations

The latest GOLD reports emphasize an ABE assessment:

• A: low symptoms, low exacerbation risk
• B: high symptoms, low exacerbation risk
• E: high exacerbation risk (previously Group D refined)

This is based on:

• symptom burden (e.g., mMRC dyspnea scale, CAT score)
• history of exacerbations and hospitalizations
• spirometry where available

Pharmacologic treatment is then tailored and escalated according to:

• symptoms (dyspnea)
• exacerbation history
• blood eosinophil counts (to help assess likely ICS benefit)

What Is Triple Therapy and Who Usually Needs It?

Triple therapy combines:

• a LAMA (e.g., tiotropium)
• a LABA
• and an ICS in a single device or regimen

Randomized trials like IMPACT and ETHOS showed that triple therapy:

• improves lung function
• improves health status
• reduces exacerbation rates compared with dual therapies (LAMA alone, LABA+LAMA, or LABA+ICS)

GOLD suggests considering triple therapy for:

• patients with recurrent exacerbations despite dual bronchodilator therapy
• those with blood eosinophil counts suggesting steroid responsiveness
• individuals where ICS is indicated and dual therapy has not achieved control

Potential Downsides of ICS and Triple Therapy

In COPD, inhaled corticosteroids can:

• increase risk of pneumonia in some patients
• cause local side effects like oral thrush if inhaler technique is poor

Thus, ICS use (and triple therapy) should be:

• targeted to those with likely benefit (frequent exacerbations, higher eosinophils)
• reassessed periodically, especially if pneumonia or other complications occur

Inhaler Technique and Adherence Are Often Overlooked

Even the best regimen fails if:

• patients can’t use the device correctly
• they forget doses
• they physically struggle with inhaler mechanisms due to arthritis, tremor, or cognitive issues

Clinical audits repeatedly show high rates of incorrect inhaler technique in COPD.

Personalization here can include:

• choosing devices matched to patient ability (pMDI vs DPI vs soft-mist inhaler)
• repeated technique coaching
• simplifying regimens where possible

Compounding is rarely needed for inhaled COPD medications, but may help with non-inhaled adjuncts, such as:

• oral medications for comorbid anxiety, GERD, or heart failure that affect breathing perceptions
• alternative forms for patients with swallowing difficulties

Support tools and patient education: Help Hub

COPD Plus Other Conditions: The Overlap with Heart Failure and Anxiety

Many COPD patients also have:

• heart failure
• anxiety or depression
• GERD
• hypertension

Symptoms can overlap:

• breathlessness may be due to COPD, heart failure, or both
• chest tightness can be respiratory, cardiac, or anxiety-driven

Medication regimens rapidly become complex.

AllMedRx can assist with:

• customizing supporting medications (for anxiety, GERD, or BP) when swallowing, interactions, or excipient sensitivities are issues
• working with clinicians to simplify regimens where possible

For shared dyspnea and symptom-overlap context: Heart Failure

Questions to Ask Your Clinician About Triple Therapy

• “How many exacerbations have I had in the past year, and what does that mean for my regimen?”
• “Have we optimized dual bronchodilator therapy before moving to triple therapy?”
• “What is my blood eosinophil count, and how does it affect ICS decisions?”
• “How can we make sure my inhaler technique is correct?”

Final Thoughts: Triple Therapy Is a Tool, Not the Whole Strategy

In 2025, COPD care goes beyond choosing an inhaler. It includes:

• tailored pharmacologic regimens guided by GOLD
• careful attention to technique and adherence
• management of comorbid conditions
• and sometimes, medication personalization around non-inhaled therapy

AllMedRx supports this by:

• providing safe, customized formulations of supporting medications when needed
• collaborating with pulmonary and primary care teams
• reinforcing that pharmacologic therapy is part of a holistic COPD management plan

For clinicians seeking support on personalized adjunct medication strategies in COPD, contact:
intake@allmedrx.org