Management of severe COPD exacerbations: focus on beclomethasone dipropionate/formoterol/glycopyrronium bromide

Marco Mantero,^1,2 Dejan Radovanovic,³ Pierachille Santus,³ Francesco Blasi<sup>1,2

1</sup>Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; ²Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Ca’ Granda Ospedale Policlinico, Milan, Italy; ³Department of Biomedical and Clinical Sciences (DIBIC), Pulmonary Unit, University of Milan, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy

Abstract: The major determinant of the decline in lung function, quality of life, and the increased mortality risk in patients with COPD is represented by severe acute exacerbations of the disease, that is, those requiring patients’ hospitalization, constituting a substantial social and health care burden in terms of morbidity and medical resource utilization. Different long-term therapeutic strategies have been proposed so far in order to prevent and/or reduce the clinical and social impact of these events, the majority of which were extrapolated from trials initially focused on the effect of long-acting muscarinic antagonist and subsequently on the efficacy of long-acting β2-agonists in combination or not with inhaled corticosteroids. The option to employ all three classes of molecules combined, despite the limited amount of evidence in our possession, represents a choice currently proposed by international guidelines; however, current recommendations are often based mainly on observational studies or on the results of secondary outcomes in randomized controlled trials. The present narrative review evaluates the available trials that investigated the efficacy of inhaled therapy to prevent COPD exacerbations and especially severe ones, with a particular focus on beclomethasone dipropionate/formoterol/glycopyrronium bromide fixed dose combination, which is the first treatment that comprises all the three drug classes, specifically tested for the prevention of moderate and severe COPD exacerbations.

Keywords: hospitalization, COPD, triple therapy, inhaled corticosteroids, formoterol, glycopyrronium