What are the available long-acting beta-agonist (LABA) / long-acting muscarinic antagonist (LAMA) nebulizers?

From the Guidelines

Long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) nebulizer options are limited, with Lonhala Magnair (glycopyrrolate) 25 mcg twice daily being the only available LAMA nebulizer solution, and Yupelri (revefenacin) available as a once-daily LAMA nebulizer solution at 175 mcg daily. Currently, there are no LABA-only nebulizer solutions available in the US market 1. For combination therapy, patients would need to use separate products or consider inhaler options where more combination products exist. These medications work by different mechanisms to improve airflow in COPD patients - LAMAs block acetylcholine receptors to prevent bronchoconstriction, while LABAs stimulate beta-2 receptors to promote bronchodilation 1. Nebulized formulations are particularly beneficial for patients who have difficulty using inhalers properly, have severe airflow limitation, or produce large amounts of sputum.

• Key points to consider when prescribing LABA and LAMA nebulizers include:
  • Ensuring proper nebulizer technique and equipment maintenance for optimal medication delivery
  • Monitoring patients for potential side effects and adjusting treatment as needed
  • Considering alternative treatment options, such as inhalers, for patients who require combination therapy
  • Evaluating the patient's symptoms and exacerbation history to determine the best course of treatment, as recommended by the GOLD guidelines 1. It is essential to follow the GOLD guidelines and consider the patient's individual needs and medical history when selecting a LABA and LAMA nebulizer treatment plan.

From the Research

Available LABA/LAMA Nebulizers

• The following LABA/LAMA combinations are available for the treatment of COPD:
  • Umeclidinium/vilanterol 2
  • Indacaterol/glycopyrronium 2
  • Aclidinium/formoterol 2, 3, 4, 5, 6
• These combinations have been shown to improve lung function, quality of life, and reduce exacerbations in patients with COPD 2, 3, 4, 5
• The available evidence suggests that these LABA/LAMA combinations are well-tolerated and effective in the treatment of COPD 3, 4, 5

Specific Combinations

• Aclidinium/formoterol has been demonstrated to improve lung function and exercise tolerance in patients with moderate-to-severe COPD 4, 5
• Umeclidinium/vilanterol and indacaterol/glycopyrronium have also been shown to improve lung function and reduce exacerbations in patients with COPD 2, 3

Clinical Benefits

• The LABA/LAMA combinations have been shown to provide clinical benefits in lung function, quality of life, and early morning COPD symptoms in a broad cohort of COPD patients 3
• These combinations have also been demonstrated to reduce the number of exacerbations and improve health-related quality of life in patients with COPD 2, 3, 5