I don't believe that this FDA approved once daily combo has been approved in my part of the world (Europe), so I don't think there are still any real life data on it. With respect to the target group, mainly those COPD patients that are not in need of ICS, so till basically old-school GOLD stage II. You could add ICS for stage III/IV or frequent exacerbators, but I don't think there are any clear evidence based data for triple therapy so far.

It has been approved by the European MA. We still can not use it in Spain. In my opinion it will be appropriate for COPD patients with moderate to very severe obstruction (GOLD grade II to IV) without frequent exacerbations and without characteristics of ACOS (Asthma-COPD syndrome overlap).