Fixed-Dosed Dual Bronchodilators for COPD: Overview and Clinician Interview

Bronchodilators, asthma, COPD
Bronchodilators, asthma, COPD
Treating chronic obstructive pulmonary disease remains challenging, particularly in terms of choosing the appropriate fixed-dose combination bronchodilator.

More than 13 million Americans have been diagnosed with chronic obstructive pulmonary disease (COPD), and it is estimated that there are an additional 24 million people with the disease who have not yet been diagnosed.1,2 According to the World Health Organization, COPD is on track to become the third leading cause of death globally by 2030.3

“Diagnosis and treatment of COPD presents several challenges, with a growing understanding of various COPD phenotypes that require a personalized treatment approach,” wrote the authors of a recent review published in the American Journal of Medicine.4 Currently, long-acting beta-2-agonists (LABAs) and long-acting antimuscarinic bronchodilators (LAMAs) represent the mainstay of pharmacologic treatment for most patients with COPD, and evidence supports the superior efficacy of combining these agents compared with monotherapy using either agent.

An increasing body of research, including randomized controlled trials, indicates that the 4 LABA/LAMA combination devices approved by the US Food and Drug Administration achieve the following:

  • Improve forced expiratory volume in 1 second, Transition Dyspnea Index scores, and exercise capacity, and reduce exacerbation frequency in some patients, compared with placebo or monotherapy.5,6
  • Improve lung function compared with inhaled corticosteroid (ICS)/LABA combination (fluticasone propionate/salmeterol) in moderate-to-severe COPD with infrequent exacerbations.7,8
  • Improve quality of life, based on St. George’s Respiratory Questionnaire scores, compared with placebo or monotherapy.9,10

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In addition, the LABA/LAMA combinations have been shown reduce the use of daytime and nighttime rescue medication, and some findings showed a reduction in exacerbation rate. The dual bronchodilators have consistently demonstrated comparable long-term safety profiles to their monocomponents.

“The mechanisms of action of LAMAs and LABAs are different and complementary, and combining a LAMA and LABA in a single, fixed-dose inhaler can support maximal bronchodilation in patients with COPD,” the review authors concluded. It important for clinicians to develop a thorough understanding of the different agents and device options available, and “awareness of patient preferences and characteristics that should be considered to optimize personalized care for patients with COPD.”