title: Dual therapy strategies for COPD: the scientific rationale for LAMA + LABA.
abstract: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and health care expenditure worldwide. Relaxation of airway smooth muscle with inhaled bronchodilators is the cornerstone of treatment for stable COPD, with inhaled corticosteroids reserved for those with a history of exacerbations. Tiotropium has occupied center stage in COPD treatment for over 10 years and improves lung function, quality of life, exercise endurance, and reduces the risk of COPD exacerbation. Long-acting β2-agonists (LABAs) improve lung function, reduce dynamic hyperinflation, increase exercise tolerance, health-related quality of life, and reduce acute exacerbation of COPD. The combination of long-acting muscarinic antagonists (LAMAs) and LABAs is thought to leverage different pathways to induce bronchodilation using submaximal drug doses, increasing the benefits and minimizing receptor-specific side effects. Umeclidinium/vilanterol is the first combination of LAMA/LABA to be approved for use in stable COPD in USA and Europe. Additionally, indacaterol/glycopyrronium and aclidinium/formoterol have been approved in Europe and in numerous locations outside USA. Several other agents are in the late stages of development, most of which offer once-daily dosing. The benefits of new LAMA/LABA combinations include improved pulmonary function, dyspnea, and health-related quality of life, and in some cases, reduced exacerbations. These evolving treatments will provide new opportunities and challenges in the management of COPD.
authors.affiliation: United Lung and Sleep Clinic, Saint Paul, MN, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Cohen
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Miles
authors.affiliation: University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Donohue
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Ohar
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D018450:Disease Progression; D004338:Drug Combinations; D005544:Forecasting; D006801:Humans; D018727:Muscarinic Antagonists / Q000008:administration & dosage*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D003692:Delayed-Action Preparations; D004338:Drug Combinations; D018727:Muscarinic Antagonists
keywords: COPD treatment; bronchodilator; chronic bronchitis; emphysema; fixed-dose combination