Differential Trough Effects of 'Triple Therapy' on Pulmonary Function in Chronic Obstructive Pulmonary Disease (COPD)
Differential Trough Effects of 'Triple Therapy' on Pulmonary Function in Chronic Obstructive Pulmonary Disease (COPD)
Different medications are often used in combination for the condition COPD (chronic
 obstructive pulmonary disease). Some medicines act by opening the airways (bronchodilators)
 and some act as anti-inflammatories (steroids). More recently an approach of using a
 combination inhaler (containing a steroid and a long-acting bronchodilator) at the same time
 as a long acting bronchodilator of a different group of medicines (anti-cholinergics
 inhalers) has been used. This approach is sometimes called 'triple therapy'. Studies which
 have looked at these combinations usually use only standard blowing tests (spirometry) to
 test these medicines and focus on the effects of the medicines at their highest (peak)
 levels. It is some ways more relevant to study these medicines towards to end of the dose
 period (trough)- just before the next dose. This is when there is less medicine in the
 system, and differences in drug effects are more obvious. There are also more detailed
 breathing tests than spirometry which get a more detailed picture of the way the lungs
 respond to bronchodilator medicines. The investigators have studied 'triple therapy' in COPD,
 by measuring the effects at the end of the dosing interval (trough) using a range of detailed
 respiratory tests.
Inclusion Criteria:

 -  Current or ex-smokers

 -  aged over 50years

 -  FEV1/FVC ratio less than 0.7

 -  FEV1 less than 60% predicted

 Exclusion Criteria:

 -  Diagnosis of asthma, ABPA or bronchiectasis

 -  Recent RTI or steroid use

 -  Inability to perform study procedures or to give informed consent

 -  Known sensitivity to trial medications