title: Role of dual bronchodilators in COPD: A review of the current evidence for indacaterol/glycopyrronium.
abstract: In this review, we summarize the rationale for combining long-acting bronchodilators in the management of chronic obstructive pulmonary disease (COPD), and the evidence for the long-acting bronchodilator combination indacaterol/glycopyrronium (IND/GLY). Clinical practice guidelines generally recommend the use of long-acting bronchodilators in the treatment of patients with all severities of COPD, either as a first-choice or alternative-choice therapy. Combining classes of long-acting bronchodilators can result in superior improvements in lung function and clinical outcomes compared with bronchodilator monotherapy, as observed in studies of free combinations of long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs). LABA/LAMA fixed-dose combinations (FDCs) can also significantly improve lung function, dyspnea, symptoms and health status and reduce exacerbations and rescue medication use versus an inhaled corticosteroid/LABA, with a comparable safety profile and lower incidence of pneumonia. The LABA/LAMA FDC of IND/GLY is approved for use in the management of COPD. This review summarizes the evidence for IND/GLY, including its pharmacodynamic and pharmacokinetic profile, and published efficacy and safety data from clinical trials in patients with COPD. We also explore the unmet needs in COPD and discuss the potential future of COPD management.
authors.affiliation: Department for Respiratory Medicine, Allergology and Sleep Medicine, Nuernberg General Hospital, Nuremberg, Germany; Department for Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, Nuremberg, Germany. Electronic address: ficker@klinikum-nuernberg.de.
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ficker
authors.affiliation: Lung Clinic Grosshansdorf, and Department of Medicine Christian Albrecht University Kiel, Kiel, Germany.
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Rabe
authors.affiliation: Department of Pulmonary and Infectious Diseases at Hannover University School of Medicine, Hannover, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
mesh_terms: D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects; D000818:Animals; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D004338:Drug Combinations; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006024:Glycopyrrolate / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology / Q000031:analogs & derivatives; D006801:Humans; D007189:Indans / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D015363:Quinolones / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D012720:Severity of Illness Index
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D004338:Drug Combinations; D005938:Glucocorticoids; D007189:Indans; D018727:Muscarinic Antagonists; D015363:Quinolones; C554862:indacaterol-glycopyrronium combination; D006024:Glycopyrrolate
keywords: COPD; Dual bronchodilation; Glycopyrronium; Human; Indacaterol; QVA149