title: Formoterol fumarate + glycopyrrolate for the treatment of chronic obstructive pulmonary disease.
abstract: Chronic obstructive pulmonary disease (COPD) is characterized by a high disability and increasing mortality. Bronchodilators are the cornerstone of pharmacological treatment in COPD, while therapeutic optimization with an improvement in symptoms and compliance represent the actual goals. This has led to the development of devices that combine different classes of inhalatory drugs. Recently, a novel combination of the long acting antimuscarinic agent glycopyrronium bromide and the beta2-agonist formoterol fumarate has been developed in a metered dose inhaler delivery system.
  
  
  
  The present article will discuss the current unmet needs in pharmacological therapy of COPD, will then briefly cover the pharmacokinetic and pharmacodynamic characteristics of the formoterol/glycopyrronium fixed dose combination and present the novel delivery system based on engineered microparticles and the co-suspension technology. Finally, efficacy and safety results of phase I, II and III trials will be reviewed. Expert commentary: The novel combination therapy of formoterol/glycopyrronium is the first available as a metered dose inhaler and proved to have a good efficacy and safety profile compared to monocomponents and tiotropium. Although still limited, data from phase III trials provide good evidence to consider it a valid option in the pharmacological management of patients with COPD.
authors.affiliation: a Health Sciences Department, Pulmonary Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan-IRCCS , Università degli Studi di Milano , Milan , Italy.
authors.forename: Dejan
authors.initials: D
authors.lastname: Radovanovic
authors.affiliation: b Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Cardio-thoracic Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano , Milan , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mantero
authors.affiliation: c Health Sciences Department, Respiratory Unit, San Paolo and Carlo Hospital , Università degli Studi di Milano , Milan , Italy.
authors.forename: Giuseppe Francesco
authors.initials: GF
authors.lastname: Sferrazza Papa
authors.affiliation: d San Donato Milanese , Università degli Studi di Milano , Milan , Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valenti
authors.affiliation: b Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Cardio-thoracic Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano , Milan , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.affiliation: c Health Sciences Department, Respiratory Unit, San Paolo and Carlo Hospital , Università degli Studi di Milano , Milan , Italy.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Di Marco
authors.affiliation: a Health Sciences Department, Pulmonary Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan-IRCCS , Università degli Studi di Milano , Milan , Italy.
authors.forename: Pierachille
authors.initials: P
authors.lastname: Santus
mesh_terms: D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D000068759:Formoterol Fumarate / Q000627:therapeutic use*; D006024:Glycopyrrolate / Q000627:therapeutic use*; D006801:Humans; D036501:Metered Dose Inhalers; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D001993:Bronchodilator Agents; D004338:Drug Combinations; D018727:Muscarinic Antagonists; D006024:Glycopyrrolate; D000068759:Formoterol Fumarate
keywords: Formoterol fumarate; bronchodilation; chronic obstructive pulmonary disease; fixed dose combination; glycopyrronium bromide; metered dose inhaler; porous particles