Bronchodilator Combination Therapy for the Treatment of Chronic Obstructive Pulmonary Disease

Abstract

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, and its prevalence is rising worldwide. Bronchodilators remain the cornerstone of COPD treatment, especially inhaled β2-adrenergic receptor agonists and inhaled anticholinergics. Long-acting bronchodilators are considered more effective and convenient than short-acting bronchodilators for the maintenance treatment in patients with moderate to very severe COPD. There are currently 3 long-acting inhaled bronchodilators available in the United States: the β2-adrenergic receptor agonists formoterol and salmeterol, and the anticholinergic, tiotropium. All 3 long-acting bronchodilators have been shown to be effective and well tolerated for the management of patients with stable COPD in clinical studies. The combination of β2-adrenergic receptor agonists and anticholinergics has been shown to provide superior bronchodilatory effect than either agent alone, possibly because of different mechanisms of action of these agents. The current treatment guidelines recommend the use of one or more long-acting bronchodilators for patients with moderate to severe stable COPD who remain symptomatic with single-agent bronchodilator therapy. The objective of this article is to review clinical data on combined bronchodilator therapy with β2-adrenergic receptor agonists and anticholinergics in patients with COPD.

Is ‘GOLD’ standard for the management of COPD in clinical practice?

“…The combination is only second-line therapy in GOLD 2011, but it is an important combination. Studies with COPD patients combining a LAMA and a LABA have demonstrated greater improvements in lung function (specifically FEV 1 ) than either bronchodilator alone [51]. β 2 -adrenergic receptor agonists bind to β 2 adrenoreceptors on the surface of smooth muscle cells at all levels of the airways (even in the small airways involved in COPD), leading directly to relaxation of smooth muscle and subsequent bronchodilation [52, 53].…”

The Role of Fixed-Dose Dual Bronchodilator Therapy in Treating COPD

“…9,10 Additional factors, including patient adherence and inhaler technique, also contribute to treatment outcomes. 11 Long-acting bronchodilator therapy is the cornerstone treatment for most patients with COPD; 4,12 for some patients with mild disease, and low symptom burden, short-acting bronchodilators may suffice for symptom control, 4 but in many cases they should be used only as rescue medications. Inhaled long-acting β2-agonists (LABAs) and long-acting anticholinergic (or antimuscarinic) bronchodilators (LAMAs) are regularly used for maintenance treatment.…”

“…Inhaled long-acting β2-agonists (LABAs) and long-acting anticholinergic (or antimuscarinic) bronchodilators (LAMAs) are regularly used for maintenance treatment. 5,12 Combining bronchodilators of different pharmacological classes may improve efficacy and decrease the risk of side effects compared with higher doses of monocomponents. 13 Four fixed-dose LAMA/LABA combinations are now available in the US in a single delivery device; however, it may be unclear which patients would benefit more from dual rather than single bronchodilator therapy as initial treatment, and which inhaler device would be most appropriate for each patient.…”

Umeclidinium bromide/vilanterol combination in the treatment of chronic obstructive pulmonary disease: a review

“…1 Combining bronchodilators of different classes leads to an improvement in efficacy with fewer adverse events in comparison with increased doses of the monocomponents. 15 …”