What are the Long-Acting Beta Agonists (LABAs) for Chronic Obstructive Pulmonary Disease (COPD)?

Long-Acting Beta Agonists (LABAs) for COPD

The primary long-acting beta agonists (LABAs) for COPD are salmeterol, formoterol, indacaterol, and olodaterol, which are recommended as maintenance therapy for patients with persistent symptoms or exacerbation risk. 1, 2

Available LABAs for COPD

• Formoterol: A twice-daily LABA with rapid onset of action, administered at 20 mcg/2 mL via nebulizer every 12 hours 3
• Salmeterol: A twice-daily LABA with 12-hour duration of action 4
• Indacaterol: A 24-hour acting LABA allowing once-daily dosing 1
• Olodaterol: A once-daily LABA often combined with tiotropium (a LAMA) 5

Efficacy of LABAs in COPD

• LABAs significantly improve lung function, reduce dyspnea, and enhance quality of life in COPD patients 2
• Treatment with salmeterol 50 mcg twice daily produces modest increases in FEV1 (51 mL improvement) and reduces exacerbations compared to placebo 4
• LABAs reduce supplemental short-acting bronchodilator usage by approximately one puff per day 4
• LABAs improve health-related quality of life and reduce the risk of COPD exacerbations 1

Role of LABAs in COPD Treatment Algorithm

• For Group A patients (low symptoms, low exacerbation risk): Short-acting bronchodilators are first-line, but LABAs may be used based on individual response 1
• For Group B patients (high symptoms, low exacerbation risk): A long-acting bronchodilator (LABA or LAMA) is recommended as initial therapy 1, 2
• For Group C patients (low symptoms, high exacerbation risk): LAMA monotherapy is preferred over LABA due to superior exacerbation prevention 1, 2
• For Group D patients (high symptoms, high exacerbation risk): LABA/LAMA combination is recommended as initial therapy 1

LABAs vs. LAMAs in COPD

• LAMAs have demonstrated greater efficacy than LABAs in reducing COPD exacerbations and exacerbation-related hospitalizations 1, 2
• In direct comparisons, tiotropium (LAMA) was superior to LABAs in preventing exacerbations, though there were no significant differences in mortality, symptoms, or lung function 1
• For patients with persistent exacerbations, a LABA/LAMA combination is preferred over LABA/ICS due to lower pneumonia risk 1

LABA Combinations in COPD

• LABA/LAMA combinations provide superior bronchodilation compared to monotherapy with either agent 6
• LABA/LAMA combinations show superior results in patient-reported outcomes compared to single bronchodilators 1
• Aclidinium-formoterol is a twice-daily LABA/LAMA combination that provides fast and sustained bronchodilation 6
• LABA/ICS combinations may be considered for patients with frequent exacerbations despite appropriate treatment with long-acting bronchodilators 1, 2
• Triple therapy (LABA/LAMA/ICS) may be beneficial for patients with severe COPD and frequent exacerbations despite dual therapy 7, 2

Important Considerations and Limitations

• LABAs are not indicated for the treatment of acute deteriorations of COPD 3, 5
• Excessive use of LABAs can result in clinically significant cardiovascular effects and may be fatal 3, 5
• Use LABAs with caution in patients with cardiovascular disorders, thyrotoxicosis, or sensitivity to sympathomimetic drugs 3, 5
• The choice between different LABAs should depend on individual patient response, as there is no clear evidence to recommend one LABA over another for symptom relief 1
• For patients with persistent breathlessness on monotherapy, the use of two bronchodilators (LABA/LAMA) is recommended 1

Administration Considerations

• Formoterol is administered via nebulizer twice daily 3
• Salmeterol and formoterol require twice-daily administration 1, 4
• Indacaterol and olodaterol allow for once-daily dosing 1, 5
• Less frequent dosing may improve medication adherence, which significantly impacts patient outcomes including mortality and hospital admissions 1