Combination Bronchodilator Therapy in COPD Management
Combination Bronchodilator Therapy in COPD Management
Chronic obstructive pulmonary disease (COPD) represents a significant cause of global morbidity and mortality, with a substantial economic impact. Recent changes in the Global initiative for chronic Obstructive Lung Disease (GOLD) guidance refined the classification of patients for treatment using a combination of spirometry, assessment of symptoms, and/or frequency of exacerbations. The aim of treatment remains to reduce existing symptoms while decreasing the risk of future adverse health events. Long-acting bronchodilators are the mainstay of therapy due to their proven efficacy. GOLD guidelines recommend combining long-acting bronchodilators with differing mechanisms of action if the control of COPD is insufficient with monotherapy, and recent years have seen growing interest in the additional benefits that combination of long-acting muscarinic antagonists (LAMAs), typified by tiotropium, with long-acting β2-agonists (LABAs), such as formoterol and salmeterol. Most studies have examined free combinations of currently available LAMAs and LABAs, broadly showing a benefit in terms of lung function and other patient-reported outcomes, although evidence is limited at present. Several once- or twice-daily fixed-dose LAMA/LABA combinations are under development, most involving newly developed monotherapy components. This review outlines the existing data for LAMA/LABA combinations in the treatment of COPD, summarizes the ongoing trials, and considers the evidence required to inform the role of LAMA/LABA combinations in treatment of this disease.
Currently the fourth leading cause of death globally, chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, projected to become the world's third leading cause of mortality by 2020. Characterized by progressive airflow limitation, COPD also has a major economic impact, contributing to US$53.7 billion in related direct costs in 2008 in the US.
As an area of interest for physicians, and a logical progression from monotherapy for those seeking to further improve outcomes in patients with respiratory disease, the subject of combined bronchodilation with bronchodilators of differing modes of action has been discussed in the literature previously. The aim of this review is to focus more specifically on the combination of long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) for the treatment of COPD, summarizing data from recent peer-reviewed publications and published abstracts.
Abstract and Introduction
Abstract
Chronic obstructive pulmonary disease (COPD) represents a significant cause of global morbidity and mortality, with a substantial economic impact. Recent changes in the Global initiative for chronic Obstructive Lung Disease (GOLD) guidance refined the classification of patients for treatment using a combination of spirometry, assessment of symptoms, and/or frequency of exacerbations. The aim of treatment remains to reduce existing symptoms while decreasing the risk of future adverse health events. Long-acting bronchodilators are the mainstay of therapy due to their proven efficacy. GOLD guidelines recommend combining long-acting bronchodilators with differing mechanisms of action if the control of COPD is insufficient with monotherapy, and recent years have seen growing interest in the additional benefits that combination of long-acting muscarinic antagonists (LAMAs), typified by tiotropium, with long-acting β2-agonists (LABAs), such as formoterol and salmeterol. Most studies have examined free combinations of currently available LAMAs and LABAs, broadly showing a benefit in terms of lung function and other patient-reported outcomes, although evidence is limited at present. Several once- or twice-daily fixed-dose LAMA/LABA combinations are under development, most involving newly developed monotherapy components. This review outlines the existing data for LAMA/LABA combinations in the treatment of COPD, summarizes the ongoing trials, and considers the evidence required to inform the role of LAMA/LABA combinations in treatment of this disease.
Introduction
Currently the fourth leading cause of death globally, chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, projected to become the world's third leading cause of mortality by 2020. Characterized by progressive airflow limitation, COPD also has a major economic impact, contributing to US$53.7 billion in related direct costs in 2008 in the US.
As an area of interest for physicians, and a logical progression from monotherapy for those seeking to further improve outcomes in patients with respiratory disease, the subject of combined bronchodilation with bronchodilators of differing modes of action has been discussed in the literature previously. The aim of this review is to focus more specifically on the combination of long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) for the treatment of COPD, summarizing data from recent peer-reviewed publications and published abstracts.