Pharmacological interaction between LABAs and LAMAs in the airways: optimizing synergy

Progress and Prospects for Long-Acting Β 2 -Agonists in the Treatment of Chronic Obstructive Pulmonary Disease (Copd)

“…In any case, it is possible that the safety warning released by the U.S. and, actually, vilanterol has not been introduced into the market as a single agent.On the other hand, an emphasized contraindication to LABA monotherapy without another controller medicationat least in asthma [70] and the documented best pharmacological effect that is achieved by combining a LABA with a LAMA [11] with a larger bronchodilation and a better improvement in patient-reported outcomes and a better improvement in some patient-reported outcomes in patients with COPD [12] are strong arguments against the use the ultra-LABAs as monotherapy. This contrasts with the evidence that at least in US new LABA starts have been significantly reduced over time among those with a diagnosis of asthma, but they are largely unchanged in those without such a diagnosis [71].…”

“…The Adelphi Respiratory Disease Specific Programme, a cross-sectional survey of consulting patients in five European countries and in the US, showed a conflict between the current real-world practice and the GOLD 2011 updated treatment recommendations, documenting that even large proportions of patients in the low risk groups were currently receiving ICS/ LABA, either alone or in combination with a LAMA [68]. Furthermore, LABAs as monotherapy were only prescribed in a small percentage of patients in GOLD group A and B.The documentation that in real life, the switch from LAMA to LABA and also the step downs of ICS/LABA to LABA or LAMA are infrequent [69] is interesting to understand the progressive decline in interest in developing new ultra-LABAs as monotherapy.In any case, it is possible that the safety warning released by the U.S. and, actually, vilanterol has not been introduced into the market as a single agent.On the other hand, an emphasized contraindication to LABA monotherapy without another controller medicationat least in asthma [70] and the documented best pharmacological effect that is achieved by combining a LABA with a LAMA [11] with a larger bronchodilation and a better improvement in patient-reported outcomes and a better improvement in some patient-reported outcomes in patients with COPD [12] are strong arguments against the use the ultra-LABAs as monotherapy. This contrasts with the evidence that at least in US new LABA starts have been significantly reduced over time among those with a diagnosis of asthma, but they are largely unchanged in those without such a diagnosis [71].…”

“…Alternatively, we can suppose the possibility of starting the treatment of COPD patients administering low doses of LABA/LAMA combinations in order to optimize the bronchodilation [75]. This alternative approach would provide a patient-tailored therapy, with the further relevant advantage of reducing the risk of potential adverse events that characterize both LABAs and LAMAs, especially when inhaled at the full doses currently approved for the treatment of COPD [11].This will mean that we should have available different doses of LABA/LAMA FDCs, a nonirrational eventuality considering that, as already mentioned, the twice-daily indacaterol/glycopyrrolate 27.5/15.6 μg seems to be as effective the once daily indacaterol/ glycopyrronium110/50 μg FDC [12].Transparency. России, Россия, 420012, Казань, ул.…”

“…In the last three years, apart from the publication of some of our original contributions focused primarily on understanding the value of dual bronchodilation [7][8][9][10][11][12], in which surely β 2 -agonists play a fundamental role, we examined and described the development of single ultra-LABAs now entered into the daily practice as monotherapy or in combination with a longacting muscarinic antagonist (LAMA) or an inhaled corticosteroid (ICS) [13][14][15][16][17][18][19][20][21].…”

Individualized Approach, Evidence, Practice (Based on Proceedings of the 26th National Congress on Respiratory Diseases)

“…Так, в иссле довании комбинации вилантерола / умеклидиния бромида (Аноро Эллипта ® ) разница с тиотропием по среднему изменению конечного ОФВ 1 от исходного значения составила 146 мл у пациентов, не получав ших лечения, и 95 мл -в общей группе [34]. Учиты вая подобные данные, ряд экспертов предлагают на чинать лечение ХОБЛ у больных с выраженной одышкой сразу с комбинаций длительно действую щих бронхолитических препаратов [34,35].…”