Pharmacotherapy of LAMA/LABA inhaled therapy combinations for chronic obstructive pulmonary disease: a clinical overview

ABSTRACT

Introduction

Long-acting muscarinic receptor antagonist (LAMA)/β₂-agonist (LABA) combinations represent a significant improvement in the treatment of chronic obstructive pulmonary disease (COPD) due to their remarkable ability to improve lung function, dyspnea, quality of life, and exercise capacity compared to mono-components.

Areas covered

This article aims to report the latest information on the clinical impact of dual bronchodilation in COPD.

Expert opinion

The available data supports the use of inhaled LAMA/LABA FDCs in treating COPD patients, particularly those with severe or very severe disease. These combinations provide short – and long-term benefits to COPD patients without increasing the dose of the single components, which reduces the risk of adverse events while ensuring an improvement in clinical efficacy. Unfortunately, head-to-head studies comparing all exiting LABA/LAMA combinations are relatively few. Since each available LAMA/LABA combination has a unique efficacy/safety profile that must be considered for personalized COPD therapy, further randomized controlled trials and real-world studies lasting at least one year are needed to assess what differences, if any, there are in terms of clinical outcomes when dual LAMA/LABA inhalers are compared to LAMA or LABA single inhalers, and to compare different LAMA/LABA FDCs.

KEYWORDS:

• COPD
• lamas
• labas
• fixed-dose combinations
• comparative studies
• guidelines

Article highlights

• More aggressive treatment may be required in many COPD patients taking long-acting bronchodilators as monotherapy.

• An additional dose of the current bronchodilator does not substantially improve lung function in many patients.

• Co-administration of LAMA and LABA provides short- and long-term clinical benefits to COPD patients.

• Dual bronchodilation is included in all treatment schemes of the various COPD treatment guidelines or strategies.

• It remains to be determined whether starting therapy with a dual bronchodilator rather than a single long-acting bronchodilator results in changes, if any, in terms of clinical outcomes.

• There is a need to compare different LAMA/LABA FDCs in this context.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.