Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Proof Of Concept Study To Evaluate Tiotropium as Add-on Therapy to Inhaled Budesonide/Formoterol Combination in COPD
Brief Summary: Different medications are often used in combination for the condition COPD (chronic obstructive pulmonary disease). Some medicines act by opening the airways (bronchodilators) and some act as anti-inflammatories (steroids). More recently an approach of using a combination inhaler (containing a steroid and a long-acting bronchodilator) at the same time as a long acting bronchodilator of a different group of medicines (anti-cholinergics inhalers) has been used. This approach is sometimes called 'triple therapy'. Studies which have looked at these combinations usually use only standard blowing tests (spirometry) to test these medicines and focus on the effects of the medicines at their highest (peak) levels. It is some ways more relevant to study these medicines towards to end of the dose period (trough)- just before the next dose. This is when there is less medicine in the system, and differences in drug effects are more obvious. There are also more detailed breathing tests than spirometry which get a more detailed picture of the way the lungs respond to bronchodilator medicines. The investigators have studied 'triple therapy' in COPD, by measuring the effects at the end of the dosing interval (trough) using a range of detailed respiratory tests.


Options:
A: Arm Label: Tio + 1xICS || LABA + 1xICS || 2xICS; Type: EXPERIMENTAL; Interventions: Drug: tiotropium bromide, Drug: salmeterol xinafoate, Drug: beclomethasone dipropionate | Arm Label: TIO + 1xICS || 2xICS || LABA + 1xICS; Type: EXPERIMENTAL; Interventions: Drug: tiotropium bromide, Drug: salmeterol xinafoate, Drug: beclomethasone dipropionate | Arm Label: LABA + 1xICS || Tio + 1xICS || 2xICS; Type: EXPERIMENTAL; Interventions: Drug: tiotropium bromide, Drug: salmeterol xinafoate, Drug: beclomethasone dipropionate | Arm Label: LABA + 1xICS || 2xICS || Tio + 1xICS; Type: EXPERIMENTAL; Interventions: Drug: tiotropium bromide, Drug: salmeterol xinafoate, Drug: beclomethasone dipropionate | Arm Label: 2xICS || Tio + 1xICS| || LABA + 1xICS; Type: EXPERIMENTAL; Interventions: Drug: tiotropium bromide, Drug: salmeterol xinafoate, Drug: beclomethasone dipropionate | Arm Label: 2xICS || LABA + 1xICS || Tio + 1xICS; Type: EXPERIMENTAL; Interventions: Drug: tiotropium bromide, Drug: salmeterol xinafoate, Drug: beclomethasone dipropionate | Intervention Type: DRUG; Name: tiotropium bromide; Assigned to Arm(s): 2xICS || LABA + 1xICS || Tio + 1xICS, 2xICS || Tio + 1xICS| || LABA + 1xICS, LABA + 1xICS || 2xICS || Tio + 1xICS, LABA + 1xICS || Tio + 1xICS || 2xICS, TIO + 1xICS || 2xICS || LABA + 1xICS, Tio + 1xICS || LABA + 1xICS || 2xICS | Intervention Type: DRUG; Name: salmeterol xinafoate; Assigned to Arm(s): 2xICS || LABA + 1xICS || Tio + 1xICS, 2xICS || Tio + 1xICS| || LABA + 1xICS, LABA + 1xICS || 2xICS || Tio + 1xICS, LABA + 1xICS || Tio + 1xICS || 2xICS, TIO + 1xICS || 2xICS || LABA + 1xICS, Tio + 1xICS || LABA + 1xICS || 2xICS | Intervention Type: DRUG; Name: beclomethasone dipropionate; Assigned to Arm(s): 2xICS || LABA + 1xICS || Tio + 1xICS, 2xICS || Tio + 1xICS| || LABA + 1xICS, LABA + 1xICS || 2xICS || Tio + 1xICS, LABA + 1xICS || Tio + 1xICS || 2xICS, TIO + 1xICS || 2xICS || LABA + 1xICS, Tio + 1xICS || LABA + 1xICS || 2xICS
B: Arm Label: Symbicort+TIO; Type: ACTIVE_COMPARATOR; Interventions: Drug: Symbicort (budesonide/formoterol turbuhaler 320/9ug) | Arm Label: Spiriva® + Placebo Turbuhaler; Type: ACTIVE_COMPARATOR; Interventions: Drug: Spiriva (tiotropium bromide 18ug) | Intervention Type: DRUG; Name: Symbicort (budesonide/formoterol turbuhaler 320/9ug); Assigned to Arm(s): Symbicort+TIO | Intervention Type: DRUG; Name: Spiriva (tiotropium bromide 18ug); Assigned to Arm(s): Spiriva® + Placebo Turbuhaler
C: Intervention Type: DRUG; Name: Tiotropium + SERETIDE 50/500; Assigned to Arm(s): N/A
D: Arm Label: Triple therapy; Type: ACTIVE_COMPARATOR; Interventions: Drug: Budesonide/formoterol and tiotropium | Arm Label: Combination therapy; Type: PLACEBO_COMPARATOR; Interventions: Drug: Budesonide/formoterol and placebo | Intervention Type: DRUG; Name: Budesonide/formoterol and tiotropium; Assigned to Arm(s): Triple therapy | Intervention Type: DRUG; Name: Budesonide/formoterol and placebo; Assigned to Arm(s): Combination therapy

Answer: D