title: Combined bronchodilators (tiotropium plus olodaterol) for patients with chronic obstructive pulmonary disease.
abstract: Chronic obstructive pulmonary disease (COPD), a respiratory disease characterized by a progressive decline in lung function, is considered to be a leading cause of morbidity and mortality. Long-acting inhaled bronchodilators, such as long-acting β2 agonists (LABAs) or long-acting muscarinic antagonists (LAMAs), are the cornerstone of maintenance therapy for patients with moderate-to-very-severe COPD. For patients not sufficiently controlled on a single long-acting bronchodilator, a combination of different bronchodilators has shown a significant increase in lung function. Tiotropium, a once-daily dosing LAMA, demonstrated sustained improvements in lung function as well as improved health-related quality of life, reduced exacerbations, and increased survival without altering the rate of decline in the mean forced expiratory volume in 1 second (FEV1) with fairly tolerable side effects. Olodaterol is a once-daily dosing LABA that has proven to be effective in improving lung function, reducing rescue medication use, and improving dyspnea and health-related quality of life, as well as improving exercise endurance with an acceptable safety profile. The combination of olodaterol and tiotropium provided additional improvements in lung function greater than monotherapy with each drug alone. Several well-designed randomized trials confirmed that the synergistic effect of both drugs in combination was able to improve lung function and health-related quality of life without a significant increase in adverse effects. The objective of this paper is to review available evidence on the clinical efficacy and safety of tiotropium, olodaterol, and their combination in patients with COPD.
authors.affiliation: Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon.
authors.forename: Wijdan H
authors.initials: WH
authors.lastname: Ramadan
authors.affiliation: Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon.
authors.forename: Wissam K
authors.initials: WK
authors.lastname: Kabbara
authors.affiliation: Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon.
authors.forename: Ghada M
authors.initials: GM
authors.lastname: El Khoury
authors.affiliation: School of Pharmacy, Lebanese American University, Byblos, Lebanon.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Al Assir
mesh_terms: D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000493:pharmacokinetics; D048588:Benzoxazines / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000493:pharmacokinetics; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000493:pharmacokinetics; D018680:Cholinergic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000493:pharmacokinetics; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D004338:Drug Combinations; D016527:Drug Costs; D004357:Drug Synergism; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D011788:Quality of Life; D020127:Recovery of Function; D000069447:Tiotropium Bromide / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000493:pharmacokinetics; D016896:Treatment Outcome
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D048588:Benzoxazines; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D004338:Drug Combinations; C549647:olodaterol; D000069447:Tiotropium Bromide
keywords: bronchodilators; chronic obstructive pulmonary disease; long-acting muscarinic antagonist; long-acting β2 agonists; olodaterol; tiotropium