What are examples of Long-Acting Beta-Agonist (LABA) and Long-Acting Muscarinic Antagonist (LAMA) inhalers for Chronic Obstructive Pulmonary Disease (COPD) treatment?

Examples of LABA and LAMA Inhalers for COPD Treatment

Long-acting bronchodilators, including LABAs and LAMAs, are cornerstone medications for COPD management, improving lung function, reducing exacerbations, and enhancing quality of life. 1

Long-Acting Beta-Agonists (LABAs)

LABAs work by relaxing bronchial smooth muscle and improving airflow. Common examples include:

• Formoterol - Available as inhalation solution (20 mcg/2 mL) administered twice daily via nebulizer 2
• Salmeterol - 12-hour duration of action, twice-daily dosing
• Indacaterol - 24-hour duration of action, once-daily dosing
• Olodaterol - 24-hour duration of action, once-daily dosing
• Vilanterol - 24-hour duration of action, once-daily dosing (available only in combination products)

Long-Acting Muscarinic Antagonists (LAMAs)

LAMAs block acetylcholine's action on muscarinic receptors, preventing bronchoconstriction. Examples include:

• Tiotropium - Once-daily dosing, available in various delivery devices including Respimat (2.5 mcg per actuation) 3
• Umeclidinium - Once-daily dosing
• Glycopyrronium (also called glycopyrrolate) - Once-daily dosing
• Aclidinium - Twice-daily dosing

LABA/LAMA Combination Inhalers

Combination therapy provides enhanced bronchodilation through complementary mechanisms:

• Tiotropium/Olodaterol (Stiolto Respimat) - 2.5 mcg/2.5 mcg per actuation, two inhalations once daily 3
• Umeclidinium/Vilanterol - Once-daily dosing
• Glycopyrronium/Indacaterol - Once-daily dosing
• Aclidinium/Formoterol - Twice-daily dosing

Clinical Considerations

Efficacy

• LAMAs have demonstrated greater efficacy than LABAs in reducing COPD exacerbations and exacerbation-related hospitalizations 1
• LABA/LAMA combinations increase lung function more effectively than LAMA monotherapy 1
• In the DETECT study, all three major LABA/LAMA combinations (aclidinium/formoterol, glycopyrronium/indacaterol, and umeclidinium/vilanterol) provided significant improvements in lung function, quality of life, and reduction in exacerbations 4

Administration Frequency

• Some LABAs require twice-daily dosing (formoterol, salmeterol, aclidinium)
• Newer LABAs (indacaterol, olodaterol, vilanterol) and most LAMAs allow for once-daily dosing
• Less frequent dosing may improve medication adherence 1

Potential Adverse Effects

• LABAs: Cardiovascular effects, tremor, hypokalemia, hyperglycemia 2
• LAMAs: Dry mouth, urinary retention, worsening of narrow-angle glaucoma 3
• Caution in patients with cardiovascular disorders, convulsive disorders, thyrotoxicosis, or sensitivity to sympathomimetic drugs 3, 2

Treatment Approach

When initiating therapy for COPD:

1. Start with a short-acting beta-agonist as needed
2. Add a long-acting bronchodilator for maintenance therapy
3. Consider LABA/LAMA combinations for patients with persistent symptoms or frequent exacerbations

Important Warnings

• LABAs should not be used as monotherapy in asthma (contraindicated) 3, 2
• Neither LABAs nor LAMAs are indicated for the relief of acute symptoms or exacerbations 3, 2
• Proper inhaler technique is crucial for optimal medication delivery and outcomes 1

The choice between specific LABA and LAMA agents should consider factors such as dosing frequency, device preferences, and individual patient response.