Indeed, depending on the country, there may be predominant use of combinations containing ICS (either LABA/ICS or LABA/LAMA/ICS). Despite consistent guideline recommendations for the broad use of single/dual bronchodilators as maintenance therapy in patients with COPD, real-world data indicate that bronchodilator therapy without an ICS is not always the most widely prescribed therapy in COPD. However, some guidelines, such as the practical guidance published by the American Thoracic Society (ATS), go further, issuing a strong recommendation for the use of LABA/LAMA over monotherapy in patients with COPD and dyspnea or exercise intolerance. National and regional guidelines for COPD are broadly consistent with the GOLD report, recommending single bronchodilator therapy as initial treatment, followed by dual therapy in patients who experience persistent dyspnea and/or exacerbations. LABA, long-acting β 2-agonist LAMA, long-acting muscarinic agent. Dosing information accurate per US, EU, and Japanese prescribing information (accessed on 10 July 2022) and Rhee et al., 2019. †† Approved dose in Europe and Japan, two puffs twice daily. * Approved dose in Europe, the USA, and Japan, two puffs once daily. The optimal components for LABA/LAMA combination therapy are not considered further in this review but are discussed elsewhere. A list of currently approved fixed-dose LABA/LAMA combinations is provided in Table 1. The second-line use of LABA/LAMA is recommended for patients who remain symptomatic despite monotherapy and for those who continue to have exacerbations but are not indicated for add-on therapy with an inhaled corticosteroid (ICS). The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2022 report recommends initial pharmacological treatment with a long-acting muscarinic antagonist (LAMA) or a long-acting β 2-agonist (LABA) for the majority of patients, and dual bronchodilator therapy (LABA/LAMA) in patients with more severe symptoms, regardless of exacerbation history. Inhaled bronchodilators (alone or in combination) have become the cornerstone of treatment for symptomatic patients with COPD, either as initial/first-line treatment or for second-line treatment in patients with persistent symptoms or exacerbations despite monotherapy.
Activity-related dyspnea has a profound impact on patients’ lives, preventing them from participating in physical activity and often leading to the adoption of a sedentary lifestyle in order to cope with symptoms. Chronic and progressive dyspnea is the most characteristic and debilitating symptom of COPD. This article reviews global and regional/national guideline recommendations for the use of LABA/LAMA in COPD, examines the evidence for the effectiveness and safety of LABA/LAMA versus other therapies and offers a practical guide for clinicians to help ensure appropriate use of LABA/LAMA therapy.Ĭhronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and persistent respiratory symptoms (most commonly dyspnea, cough and/or sputum production) and is punctuated by periods of acute worsening, known as exacerbations.
However, despite consistent guideline recommendations, real-world prescribing data indicate that LAMA and/or LABA without an inhaled corticosteroid are not the most widely prescribed therapies in COPD. The recommendations for LABA/LAMA are broader in the American Thoracic Society treatment guidelines, which strongly recommend LABA/LAMA combination therapy over LAMA or LABA monotherapy in patients with COPD and dyspnea or exercise intolerance. The Global Initiative for Chronic Obstructive Lung Disease 2022 report recommends initial pharmacological treatment with a long-acting muscarinic antagonist (LAMA) or a long-acting β 2-agonist (LABA) as monotherapy for most patients, or dual bronchodilator therapy (LABA/LAMA) in patients with more severe symptoms, regardless of exacerbation history. Inhaled bronchodilators (alone or in combination) are the cornerstone of treatment for symptomatic patients with COPD, either as initial/first-line treatment or for second-line/treatment escalation in patients who experience persistent symptoms or exacerbations on monotherapy.
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