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[Correspondence] Inhaled triple therapy in chronic obstructive pulmonary disease

In the TRIBUTE study,1 Alberto Papi and colleagues (March 17, p 1076) reported a small but significant reduction of the exacerbation rate with the addition of an inhaled corticosteroid to dual long-acting bronchodilation in patients with chronic obstructive pulmonary disease and severe or very severe airway obstruction with at least one exacerbation in the previous year. Data derived from the ISOLDE study2 showed that abruptly stopping treatment with inhaled corticosteroid was associated with an increased risk of exacerbation in about 25% of patients, with a median delay of 20 days.