Ciclesonide, Formoterol, Tiotropium

Ciclesonide, Formoterol, and Tiotropium are three individually effective medications, when combined they create a potent triple maintenance therapy for patients with chronic obstructive pulmonary disease (COPD), specifically those with severe bronchoconstriction and history of exacerbations.
Ciclesonide is an inhaled corticosteroid that is effective in reducing the inflammation associated with COPD. Inflammation in the lungs causes swelling and narrowing of the airways making it difficult to breathe. By decreasing inflammation, ciclesonide allows the bronchial tubes in the lungs to expand, providing an increased flow of air. This helps in the alleviation of symptoms such as shortness of breath and wheezing.
Formoterol, on the other hand, is a long-acting bronchodilator. It works by opening up the airways in your lungs, making it easier to breathe, it does this by stimulating receptors in the airways called beta-2 receptors to relax the smooth muscle around these airways. The relaxation leads to a decrease in airway constriction, improving airflow from the lungs.
The addition of Tiotropium as a long-acting muscarinic antagonist (LAMA), adds an additional mechanism for bronchodilation, making this combination even more effective in bronchoconstriction relief.