Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β₂-agonist bronchodilators

Figures & data

Table 1. LAMA/LABA medications available in the USA.

LAMA/LABA medication	Manufacturer	Formulation	Approval*	Dosage
Umeclidinium 62.5 mcg; Vilanterol 25 mcg	GlaxoSmithKline	DPI	December 2013	1 inhalation once daily
Tiotropium 2.5 mcg; Olodaterol 2.5 mcg	Boehringer Ingelheim	Soft mist inhalation spray	August 2015	2 inhalations
Glycopyrrolate 15.6 mcg; Indacaterol 27.5 mcg	Novartis/Sunovion	DPI	October 2015	Inhalation of powder contents of 1 capsule^† twice daily
Glycopyrrolate 15.6 mcg; Formoterol 4.8 mcg	AstraZeneca	Pressurized MDI	April 2016	2 inhalations twice daily
Aclidinium 400 mcg; Formoterol 12 mcg	Circassia	DPI	March 2019	1 inhalation twice daily

*Approved in the USA for long-term maintenance treatment of airflow obstruction in patients with COPD; ^†most patients are able to empty the capsule with 1 or 2 inhalations

DPI, dry powder inhaler; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; MDI, metered dose inhaler

Figure 1. Summary of evidence for LAMA/LABA versus LAMA and ICS/LABA.

*Few studies have assessed exacerbation risk with LAMA/LABA versus ICS/LABA, and the available data do not consistently favor either class. FEV₁, forced expiratory volume in 1 second; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; SGRQ, St George’s Respiratory Questionnaire; TDI, Transition Dyspnea Index