From the Guidelines
The cheapest combination bronchodilators are likely to be short-acting muscarinic antagonist (SAMA) plus short-acting beta-agonist (SABA) or ipratropium plus a long-acting beta-agonist.
Key Points
- Combination therapy: Using bronchodilators that target different receptors may improve clinical symptoms and prevent exacerbations 1.
- Cost-effective options: SAMA plus SABA or ipratropium plus a long-acting beta-agonist may be more cost-effective than other combination therapies, such as long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) combinations 1.
- Efficacy: Combination therapy with ipratropium and a long-acting beta-agonist has been shown to improve lung function and quality of life, with a possible reduction in exacerbations 1.
- Safety: The combination of ipratropium and a long-acting beta-agonist has been found to be safe, with improvements in functional and quality-of-life measures, and an indication of benefit in reducing the frequency of exacerbations 1.
Comparison of Combination Therapies
- LABA/LAMA combination: This combination has been shown to improve lung function, reduce symptoms, and decrease exacerbation rates compared to monotherapy 1.
- SAMA/SABA combination: This combination is likely to be less expensive than LABA/LAMA combinations and may be a more cost-effective option for patients with mild to moderate COPD.
- Ipratropium plus long-acting beta-agonist: This combination has been shown to improve lung function and quality of life, with a possible reduction in exacerbations, and may be a cost-effective alternative to LABA/LAMA combinations 1.
From the Research
Cheapest Combination Bronchodilators
The cost of combination bronchodilators can vary depending on the specific medication and the location. However, some of the most commonly used combination bronchodilators include:
- LAMA/LABA fixed-dose combinations, such as indacaterol/glycopyrronium, umeclidinium/vilanterol, and olodaterol/tiotropium 2
- These combinations provide the convenience of two bronchodilators with different mechanisms of action in a single inhaler
Factors Affecting Cost
The cost of combination bronchodilators can be affected by several factors, including:
- The specific medication and dosage form
- The location and availability of the medication
- The patient's insurance coverage and copayment requirements
- The presence of generic or alternative versions of the medication
Available Combination Bronchodilators
Some of the available combination bronchodilators include:
- Indacaterol/glycopyrronium (approved for use in COPD) 2
- Umeclidinium/vilanterol (approved for use in COPD) 2
- Olodaterol/tiotropium (approved for use in COPD) 2
- These combinations have been shown to provide effective bronchodilation and symptom relief in patients with COPD 3, 4
Development of New Combination Bronchodilators
Research is ongoing to develop new combination bronchodilators, including:
- "Triple inhalers" containing fixed-dose combinations of both classes of bronchodilator (dual bronchodilation) and an inhaled corticosteroid in the same inhaler 5
- "Bifunctional drugs" having two different primary pharmacological actions in the same molecule 5
- These new developments may provide additional treatment options for patients with COPD and other airway disorders 6