27th July 2018, Volume 131 Number 1479

Once-daily single-inhaler triple versus dual therapy in patients with COPD

Triple inhaled therapy for chronic obstructive pulmonary disease (COPD) comprises an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-antagonist (LABA). Such treatment has shown considerable benefits in several trials. However, it means that patients have to use multiple inhalers several times per day.

This report is of a trial in which a combination of the three drugs in a single inhaler is used once daily. Over 10,000 patients were randomised to treatment with the triple therapy or treatment with a LABA-LAMA or steroid-LABA combination.

The results of the trial demonstrated that the triple therapy resulted in a lower rate of moderate or severe COPD exacerbations than either of the other two treatments.

N Engl J Med 2018; 378:1671–80

Adherence to medication, glycaemic control and hospital attendance in young adults with type 2 diabetes

This important matter is reviewed in this paper which reports on data from the Greenlane Diabetes Clinic.

Information about medication adherence and glycaemic control has been correlated in 266 type 2 diabetics aged between 18 and 39 years. Adherence was assessed by documentation of drugs collected from pharmacies. Forty-seven percent were found to have good adherence and 21% of the group had very poor adherence. The mean HbA1c was 70mmol/mol in the good adherent group and 97 in the poorly adherent. There were more hospital admissions among those with very poor adherence (p=0.03).

It was concluded that this emphasises the need to assess adherence and try to understand the barriers patients face.

Internal Medicine Journal 2018; 48:728–31

UK COPD treatment: failing to progress

Recently the Royal College of Physicians has published reports on this matter which are relevant as it is estimated that there are more than a million COPD patients in the UK.

Pulmonary rehabilitation, a treatment combining an exercise regimen and education about self-care, is widely acknowledged as an effective and high-value intervention for people with COPD. However, the College reports notes that only 60% of COPD subjects are enrolled within 90 days of referral and 38% of these did not complete the treatment. Smoking cessation is known to reduce mortality in COPD patients. However, the College reports notes that only 54% of hospitals offer smoking cessation services.

An editorial writer suggests that the UK National Health Service needs to do better to provide access to these services.

Lancet 2018; 391:1550