Evidence mapPaperPMID 41998645Full record

SynthesisBMC pulmonary medicine2026

Efficacy of single-inhaler triple therapies for chronic obstructive pulmonary disease: a systematic review and network meta-analysis.

Yu Zhang, Pei Zhao, Yudong Zhang

Abstract readSystematic ReviewNetwork Meta-Analysis
In one paragraph

Synthesis in BMC pulmonary medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Yu Zhang *Department of Clinical Laboratory, Hebei General Hospital, Shijiazhuang, 050051, China.
Pei Zhao *Department of Clinical Laboratory, Hebei General Hospital, Shijiazhuang, 050051, China.
Yudong ZhangDepartment of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, 050031, China. zyd18203319863@163.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimThis study aims to systematically evaluate which single-inhaler triple therapy (inhaled corticosteroids [ICS], long-acting β2-agonists [LABA], and long-acting muscarinic antagonists [LAMA]) is safer and more effective for treating chronic obstructive pulmonary disease (COPD).

methodsA comprehensive search was performed in PubMed, Embase, Ovid, Cochrane library and Google Scholar from database establishment to November 2025. Searches were limited to English articles. The RCTs that compared single-inhaler triple therapy (ICS/LABA/LAMA) with triple therapy (ICS/LABA+LAMA) or dual therapy (ICS/LABA or LABA/LAMA) for COPD were included. Minimum duration ≥ 12 weeks and minimum participant numbers ≥ 300 patients. Outcomes included forced expiratory volume in 1 s (FEV1), moderate and severe exacerbations, St George’s Respiratory Questionnaire (SGRQ) total score and SGRQ responders, transition dyspnea index (TDI) focal score and safety.

results12 RCTs (n = 28930 patients) were included in this network meta-analysis. Fluticasone furoate/vilanterol/umeclidinium (FF/VIL/UMEC) was statistically significantly more effective at increasing trough FEV1 (based on change from baseline) than dual therapies (ICS/LABA or LABA/LAMA), free triple therapy (ICS/LABA+LAMA), budesonide/formoterol fumarate/glycopyrronium bromide (BUD/FOR/GLY) and beclomethasone dipropionate/formoterol fumarate/glycopyrronium bromide (BDP/FOR/GLY). In addition, FF/VIL/UMEC, BUD/FOR/GLY, and free triple therapy (ICS/LABA+LAMA) showed significant improvement in the total SGRQ score to dual therapies (ICS/LABA or LABA/LAMA). FF/VIL/UMEC and free triple therapy (ICS/LABA+LAMA) showed borderline significant improvement in the total SGRQ score to BDP/FOR/GLY.

conclusionThe four available single-inhaler triple therapies and free triple therapy appear to have similar effectiveness and safety. Given the absence of direct comparison studies differences cannot be found with a sufficient level of certainty. Further analysis is needed, as additional evidence becomes available.

Indexed as

Adrenal Cortex HormonesAdrenergic beta-2 Receptor AgonistsBronchodilator AgentsMuscarinic AntagonistsPulmonary Disease, Chronic ObstructiveAdministration, InhalationDrug Therapy, CombinationForced Expiratory VolumeHumansNebulizers and VaporizersQuinuclidinesRandomized Controlled Trials as TopicTreatment OutcomeAdrenal Cortex HormonesAdrenergic beta-2 Receptor AgonistsBronchodilator AgentsMuscarinic AntagonistsQuinuclidinesBeclomethasone dipropionate/ formoterol fumarate/glycopyrronium bromide (BDP/FOR/GLY)Budesonide/formoterol fumarate/glycopyrronium bromide (BUD/FOR/GLY)Chronic obstructive pulmonary diseaseFluticasone furoate/formoterol fumarate/glycopyrronium bromide (FF/FOR/GLY)Fluticasone furoate/vilanterol/umeclidinium (FF/VIL/UMEC)Single-inhaler triple therapy

Identifiers

PMID41998645
PMCPMC13217999

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.