From the Guidelines
The recommended initial treatment with a Long-Acting Muscarinic Antagonist (LAMA) inhaler for patients with Chronic Obstructive Pulmonary Disease (COPD) is typically tiotropium (Spiriva) 18 mcg once daily, umeclidinium (Incruse Ellipta) 62.5 mcg once daily, aclidinium (Tudorza Pressair) 400 mcg twice daily, or glycopyrrolate (Seebri Neohaler) 15.6 mcg twice daily, as suggested by the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1.
Key Considerations for LAMA Therapy
- For asthma, LAMAs are not generally recommended as first-line therapy but may be added as an adjunct treatment in patients with severe, uncontrolled asthma, with tiotropium being the most studied LAMA for this purpose at 5 mcg once daily (lower than the COPD dose) 1.
- When initiating LAMA therapy, patients should be instructed on proper inhaler technique specific to their device, as incorrect technique significantly reduces medication effectiveness.
- Patients should use the medication regularly as prescribed, not on an as-needed basis, since LAMAs work by maintaining bronchodilation over time.
- LAMAs function by blocking muscarinic receptors in airway smooth muscle, preventing acetylcholine-induced bronchoconstriction, which helps reduce symptoms like shortness of breath and improves lung function.
Monitoring and Side Effects
- Common side effects to monitor include dry mouth, urinary retention, and worsening of narrow-angle glaucoma, so these conditions should be assessed before starting therapy.
- The choice of LAMA should be based on individual patient factors, including symptom severity, history of exacerbations, and presence of comorbidities.
- Regular follow-up is necessary to assess the effectiveness of LAMA therapy and adjust treatment as needed to optimize patient outcomes, as recommended by recent guidelines 1.
From the Research
Recommended Initial Treatment with LAMA Inhaler
The recommended initial treatment with a Long-Acting Muscarinic Antagonist (LAMA) inhaler for patients with Chronic Obstructive Pulmonary Disease (COPD) or asthma is as follows:
- For patients with COPD, LAMA monotherapy or dual bronchodilator therapy (LABA/LAMA) may be used as initial treatment, depending on the severity of symptoms and exacerbation history 2, 3.
- For patients with asthma, the use of LAMA inhalers is not as well established, but they may be considered as an add-on therapy for patients with difficult-to-control asthma 4.
- The choice of initial treatment should be based on individual patient factors, such as symptom severity, exacerbation history, and comorbidities.
Benefits of LAMA/LABA Combination Therapy
LAMA/LABA combination therapy has been shown to have several benefits, including:
- Greater improvements in lung function and symptoms compared to LAMA monotherapy or ICS/LABA treatment 2, 5, 6.
- Similar reduction in exacerbation risk compared to LAMA monotherapy 2.
- Lower risk of pneumonia compared to ICS/LABA treatment 2.
- Improved quality of life and well-being, as measured by the COPD Assessment Test (CAT) 5.
Specific LAMA Inhalers
Several LAMA inhalers are available, including:
- Tiotropium bromide, which has been shown to be effective in patients with COPD and asthma 4.
- Glycopyrronium, which has been shown to be effective in combination with indacaterol in patients with COPD 5, 6.
- Umeclidinium, which has been shown to be effective in combination with vilanterol in patients with COPD 5.