Antonio Anzueto, MD: Advancing Triple-Therapy Inhalers for COPD


Though still not in abundance on the market, ICS/LAMA/LABA triple-therapy single inhaler treatment options are becoming more valued for COPD exacerbation and comorbid disease risk.

Budesonide 160 mcg, 9.0 mcg glycopyrrolate, and 4.8 mcg formoterol fumarate (Breztri) was among the leading triple-therapy inhaler options to reach the market for the management of chronic respiratory disease. And years later, investigators are still uncovering its key utility.

In an interview with HCPLive during the American Thoracic Society (ATS) 2023 International Conference in Washington, DC, this week, Antonio Anzueto, MD, pulmonary section chief at South Texas Veterans Healthcare System, discussed the latest research supporting the use of Breztri as a combination inhaled corticosteroid, long-acting muscarinic antagonist and long-acting beta agonist (ICS/LAMA/LABA).

Breztri was originally approved by the US Food and Drug Administration (FDA) for the treatment of COPD in July 2020, supported by findings from the phase 3 ETHOS trial showing significantly reduced risk of moderate to severe exacerbations versus ICS/LABA and LAMA/LABA.1 Among patients with poorly managed chronic obstructive pulmonary disease (COPD), recent recommendations have shifted the prioritization of ICS/LAMA/LABA options.

“For that individual who was in the hospital with an exacerbation, and that individual with multiple events while on outpatient steroids, and/or those who have an increased blood eosinophil level, the first line of therapy should be a triple-combination,” Anzueto said.

Moving parallel with this increasing appreciation for the utility of triple-combination inhaler therapy is the greater understood involvement of cardiovascular comorbidity among patients with COPD; Anzueto discussed the well-understood risk of major adverse cardiovascular events among patients who experience an exacerbation.

“And this type of therapy has been shown to significantly reduce exacerbations, and has shown some benefit in the relative reduction in mortality…and the reduction in exacerbations at the end of the day will translate to the individual having less risk of a cardiovascular event,” Anzueto said.

Along with reviewing newer data for Breztri featured at ATS 2023,2 Anzueto discussed the coming years’ research into ICS/LAMA/LABA—in which he and colleagues hope to “further characterize when to use the medication” as it relates to patients’ benefit-risk profiles.

Nonetheless, the unique regimen therapy has been a long time coming for patients and clinicians combating COPD.

“I think we need to appreciate that in order to have these 3 medications available today, it has been 20 years of extensive research,” Anzueto said. “We had to first develop the bronchodilators first. Then we had to study them individually, combine 2—combine ICS and LABAs, then LAMAs and LABAs—and then we could combine 3.”

Anzueto currently serves as a paid consultant and advisory board member for Boehringer Ingelheim, GlaxoSmithKline, Novartis, Pfizer, AstraZeneca, TEVA Pharma, and Verona Pharma.


  1. Walter K. FDA Approves COPD Triple Therapy. HCPLive. Published July 24, 2020. Accessed May 24, 2023.
  2. Pollack M, Tkacz JP, Schinkel J, Lewing B, et al. Exacerbations and Real-world Outcomes (EROS) Among Patients With COPD Receiving Single Inhaler Triple Therapy of Budesonide/glycopyrrolate/formoterol Fumarate. Presented at: American Thoracic Society (ATS) 2023 International Conference. Washington, DC. May 18 – 24, 2023.
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