Inhaled
bronchodilators, including long-acting muscarinic receptor antagonists
(LAMA) and long-acting β2-adrenoreceptor agonists
(LABA), are the mainstay of pharmacological treatment of stable chronic
obstructive pulmonary disease (COPD). Among approved LAMA, tiotropium
bromide, glycopyrronium bromide, and umeclidinium bromide are administered
once daily, whereas aclidinium bromide is administered every 12 h.
New LAMA are under development for COPD. Among the approved LABA,
indacaterol has a 24 h duration of action, whereas salmeterol and
formoterol require twice-daily administration. New once-daily LABA,
including vilanterol, olodaterol, milveterol, carmoterol, and abediterol,
are in development. LAMA/LABA fixed dose combinations (FDCs) provide
the convenience of two bronchodilators with different mechanism of
action in a single inhaler. Indacaterol/glycopyrronium, umeclidinium/vilanterol,
and olodaterol/tiotropium FDCs have been approved or are under approval
and are likely to become a standard pharmacological strategy for COPD.
Inhaled dual-pharmacology compounds, combining muscarinic antagonism and β2-agonism (MABA) in a single molecule, potentially provide
additive or synergistic bronchodilation over either inhaled antimuscarinic
or β2-agonist monotherapy.