Karner et al further confirmed the lack of general lack of evidence for "triple therapy" (inhaled corticosteroid, tiotropium, and long-acting beta agonist) for COPD. In a Cochrane analysis, they could only identify one randomized trial (n=293) testing LABA+tiotropium vs. triple-therapy (LABA+tiotropium+ICS). The trial suffered from high and uneven dropout rates between treatment arms, precluding any conclusions.
Karner C et al. The effect of adding inhaled corticosteroids to tiotropium and long-acting beta-agonists for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD009039.
A recent retrospective review in CHEST offers positive observational data that triple therapy is beneficial in COPD.