TRINOSHEL-LC Approved Indications
I cannot provide information about the approved indications for TRINOSHEL-LC because this medication does not appear in any of the provided evidence sources, including FDA drug labels, clinical guidelines, or research literature.
What the Evidence Does Support for COPD with Exacerbation History
Since you're asking about older adults with COPD and exacerbation history, here's what is actually recommended based on the highest quality evidence:
Primary Maintenance Therapy
For older adults with COPD at high risk of exacerbations (history of exacerbations), triple combination therapy with LAMA/LABA/ICS should be initiated as first-line maintenance treatment 1.
- The 2023 Canadian Thoracic Society guideline specifically recommends starting LAMA/LABA/ICS triple combination therapy as initial maintenance therapy for stable individuals with COPD at high risk of exacerbations 1.
- This recommendation is based on large RCTs (IMPACT and ETHOS) demonstrating significantly lower annual rates of moderate or severe exacerbations with triple therapy compared to dual therapy 1.
Alternative Approaches
- If triple therapy is not initiated, patients should start with LAMA/LABA dual therapy, which is superior to monotherapy for preventing exacerbations 2.
- Long-acting anticholinergics (LAMAs) and long-acting beta-agonists (LABAs) are both effective as monotherapy and should be the initial maintenance treatment if dual or triple therapy is not used 2.
Additional Considerations for Elderly Patients
- ICS use in elderly COPD patients requires caution due to increased risk of pneumonia, cataracts, diabetes, and osteoporotic fractures 3.
- Regular ICS use should follow guideline recommendations carefully, weighing expected benefits against adverse effects, particularly in elderly patients 3.
If TRINOSHEL-LC is a specific branded medication you're inquiring about, please provide the drug label or additional documentation for accurate information about its approved indications.