Tuberc Respir Dis.  2018 Jul;81(3):198-215. 10.4046/trd.2018.0040.

Optimal Bronchodilation for COPD Patients: Are All Long-Acting β₂-Agonist/Long-Acting Muscarinic Antagonists the Same?

Affiliations
  • 1Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. mmiravitlles@vhebron.net
  • 2Novartis Korea Ltd., Seoul, Korea.
  • 3Novartis Healthcare Pvt. Ltd., Hyderabad, India.

Abstract

Bronchodilators provide improvements in lung function and reductions in symptoms and exacerbations, and are the mainstay of pharmacological management of chronic obstructive pulmonary disease (COPD). The Global Initiative for Chronic Obstructive Lung Disease strategy recommends the use of a combination of long-acting β₂-agonist/long-acting muscarinic antagonists (LABA/LAMA) as the first-line treatment option in the majority of symptomatic patients with COPD. This review provides an indirect comparison of available LABA/LAMA fixed-dose combinations (FDCs) through discussion of important efficacy and safety data from the key literature, with the objective of providing physicians with a framework for informed decision-making. LABA/LAMA FDCs provided greater benefits compared with placebo and similar or greater benefits compared with tiotropium and salmeterol/fluticasone in improving lung function, dyspnea, health-related quality of life, reducing rescue medication use and preventing exacerbations, although with some variability in efficacy between individual FDCs; further, tolerability profiles were comparable among LABA/LAMA FDCs. However, there is a disparity in the amount of evidence generated for different LABA/LAMA FDCs. Thus, this review shows that all LABA/LAMA FDCs may not be the same and that care should be taken when extrapolating individual treatment outcomes to the entire drug class. It is important that physicians consider the efficacy gradient that exists among LABA/LAMA FDCs, and factors such as inhaler devices and potential biomarkers, when choosing the optimal bronchodilator treatment for long-term management of patients with COPD.

Keyword

Asian; Pulmonary Disease, Chronic Obstructive; Disease Management; Korea

MeSH Terms

Asian Continental Ancestry Group
Biomarkers
Bronchodilator Agents
Disease Management
Dyspnea
Humans
Korea
Lung
Muscarinic Antagonists*
Nebulizers and Vaporizers
Pulmonary Disease, Chronic Obstructive*
Quality of Life
Tiotropium Bromide
Biomarkers
Bronchodilator Agents
Muscarinic Antagonists
Tiotropium Bromide

Cited by  1 articles

Pharmacotherapy for chronic obstructive pulmonary disease
In Ae Kim, Yong Bum Park, Kwang Ha Yoo
J Korean Med Assoc. 2018;61(9):545-551.    doi: 10.5124/jkma.2018.61.9.545.


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