What are common long-acting beta agonist (LABA) - long-acting muscarinic antagonist (LAMA) inhaler combinations in the United States?

From the Guidelines

The most common LABA-LAMA inhaler combinations in the United States are Anoro Ellipta, Stiolto Respimat, and Bevespi Aerosphere, which are primarily used for maintenance treatment of COPD. These combinations, including umeclidinium/vilanterol, tiotropium/olodaterol, and glycopyrrolate/formoterol, provide more effective bronchodilation than either component alone 1. The LAMA component works by blocking muscarinic receptors in the airways, preventing acetylcholine-induced bronchoconstriction, while the LABA component stimulates beta-2 receptors, promoting bronchodilation. This dual mechanism provides complementary effects, improving lung function, reducing symptoms, and decreasing exacerbation risk in COPD patients.

Some key points to consider when prescribing these combinations include:

• Proper inhaler technique specific to the device
• Advising patients that these medications are not for rescue use during acute symptoms
• Considering the addition of other therapies, such as macrolide maintenance therapy or roflumilast, in patients with high risk of exacerbations or impaired health status 1
• Avoiding the use of theophylline or systemic oral corticosteroids for maintenance treatment in COPD

It's worth noting that the evidence from European guidelines suggests that LABA-LAMA combinations are a viable option for patients with COPD, particularly those with severe disease or frequent exacerbations 1. However, the most recent and highest quality study, the 2023 Canadian Thoracic Society guideline, provides more specific recommendations for the use of these combinations in patients with stable COPD 1.

From the Research

Common LABA-LAMA Inhaler Combinations

• The most common LABA-LAMA inhaler combinations in the United States include:
  • Umeclidinium/vilanterol (UMEC/VI) 2
  • QVA149 2
  • Aclidinium/formoterol 3
  • Glycopyrronium/indacaterol 3
  • Tiotropium/olodaterol 3

Availability and Usage

• These combinations are available as maintenance bronchodilator treatments to relieve symptoms in adult patients with COPD 3, 2
• The choice of LABA-LAMA combination may depend on various factors, including patient preferences, inhaler device characteristics, and clinical outcomes 4

Clinical Evidence

• Studies have shown that LABA-LAMA combinations can improve lung function, reduce exacerbations, and improve symptom and quality-of-life scores compared to monotherapies 2, 5
• The LABA-LAMA combination has been ranked as the highest treatment group to reduce COPD exacerbations, followed by LAMA-containing inhalers 5