Four trials were included in the review (1,287 participants). None of the trials reported a comparison between triple therapy and dual bronchodilator therapy (long-acting anticholinergic bronchodilator plus long-acting beta-agonist bronchodilator).
Compared to long-acting anti-cholinergic bronchodilator monotherapy, triple therapy was associated with a marginal significance for improvement in lung function as measured by FEVi (WMD 0.05L, 95% CI 0.00 to 0.11; three trials) and a significant improvement in quality of life (WMD 3.75, 95% CI 1.56 to 5.94; two trials). No substantial heterogeneity was found in these outcomes.
There were no significant differences in the rate of severe/acute exacerbations and mortality between the two groups. Substantial heterogeneity was only found in the outcome of severe/acute exacerbations (Ι²=93%).
Hospitalisation rates due to COPD exacerbations (two trials) were reduced significantly with triple therapy compared to long-acting anti-cholinergic bronchodilator monotherapy (RR 0.53, 95% CI 0.33 to 0.86 and 0.35, 95% CI 0.16 to 0.78). One trial reported a significant improvement in breathlessness using the triple therapy compared with monotherapy. Two trials did not find a significant difference in dyspnoea between the two groups.