The randomised controlled trial (GLISTEN) by Frith et al1 showed significant improvements in trough FEV1, health-related quality of life and rescue medication when long-acting muscarinic antagonists (LAMA: as either tiotropium or glycopyrronium) were added to inhaled corticosteroid/long-acting beta-agonist (ICS/LABA: as fluticasone/salmeterol) in 773 patients with moderate-to-severe COPD (FEV1 57.2%) over 12 weeks. The authors concluded that this was the first study, which conclusively demonstrates the benefits of triple therapy compared with dual therapy. In a retrospective cohort study using health informatics reported by Short et al,2 2853 patients with moderate-to-severe COPD were followed up over 4.65 years; of whom, 996 were receiving ICS/LABA (FEV1 62.7%) and 1857 receivin...