A review of current and developing fixed-dose LABA/LAMA combinations for treating COPD

ABSTRACT

Introduction: The current GOLD (Global Initiative for Chronic Obstructive Lung Disease) recommendations suggest using long acting β2 agonists (LABA) and long acting muscarinic antagonists (LAMA) in combination for group B COPD patients with persistent symptoms, group C COPD patients with further exacerbations on LAMA therapy alone and for group D COPD patients with or without combination with inhaled corticosteroids (ICS). Thus, there is a lot of interest in developing LABA/LAMA combinations for maintenance therapy of chronic stable COPD.

Areas covered: Many LABA/LAMA combinations have successfully been approved through carefully designed pivotal clinical trials. The current clinical use of LABA/LAMA combinations in COPD will continue to evolve as new trials with and without inhaled corticosteroids are completed.

Expert opinion: Combining different classes of bronchodilators in a single inhaler is an attractive concept that can potentially improve patient adherence to therapy. Because LABA/LAMA combinations are the preferred treatment option for preventing COPD exacerbations in the updated GOLD guidelines for COPD, they will be clinically used. Future treatment of COPD should revolve around a personalized approach based on characterization of the COPD phenotype.

KEYWORDS:

• Chronic obstructive pulmonary disease
• Global Initiative for Chronic Obstructive Lung Disease
• long acting β2 agonists
• long acting muscarinic antagonists
• bronchodilators

Article highlights

• LAMA/LABA combinations are recommended by the current GOLD COPD recommendations for group B COPD patients with persistent symptoms, group C COPD patients with further exacerbations on LAMA therapy alone and for group D COPD patients with or without combination with inhaled corticosteroids.

• LAMA/LABA combinations have been shown to improve lung function, lung hyperinflation, exercise capacity, quality of life and exacerbation frequnecy thereby slowing disease progression in COPD.

• Head to head clinical trial results of triple therapy with ICS/LABA/LAMA and dual therapy with LABA/LAMA therapy in COPD are pending.

• Future treatment of COPD should revolve around a personalized approach based on characterization of the COPD pneotype.

This box summarizes key points contained in the article.

Declaration of interest

C Lal has received grant support from Jazz pharmaceuticals and Invado pharmaceuticals and is a consultant for Ikaria and Cipla pharmaceuticals. C Strange has current, past, or pending grants in COPD from the Alpha-1 Foundation, Baxalta/Shire, BTG, CSL Behring, Grifols, the NIH, and Pulmonx and Novartis. He consults for AstraZeneca, CSA Medical, CSL Behring, Grifols, and Abeona on COPD. He has an equity interest in Abeona. The authors have no other 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 apart from those disclosed. A reviewer on this manuscript has disclosed work as a consultant and speaker for AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Guidotti, Novartis and Chiesi farmaceutici. A reviewer on this manuscript has disclosed consultancy/lecture fees from Merck Sharp & Dohme, AstraZeneca, Novartis, GlaxoSmithKline, Takeda, Mundipharma, Sandoz, Boehringer Ingelheim, and Teva-Handok.

Additional information

Funding

This paper was not funded.