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

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: April 3, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

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

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Dual therapy strategies for COPD: the scientific rationale for LAMA + LABA.

International journal of chronic obstructive pulmonary disease, 2016

5
Research

Aclidinium bromide/formoterol fumarate as a treatment for COPD: an update.

Expert review of respiratory medicine, 2021

Related Questions

What are the Long-Acting Beta-Agonist (LABA)/Long-Acting Muscarinic Antagonist (LAMA) combinations for Chronic Obstructive Pulmonary Disease (COPD) treatment?
What is the gold standard Long-Acting Beta-Agonist (LABA)/Long-Acting Muscarinic Antagonist (LAMA) combination for moderate Chronic Obstructive Pulmonary Disease (COPD)?
What are examples of LAMA (Long-Acting Muscarinic Antagonist) therapy for Chronic Obstructive Pulmonary Disease (COPD)?
What is the first-line LABA (Long-Acting Beta Agonist)/LAMA (Long-Acting Muscarinic Antagonist) combination for a patient with upper lobe atelectasis and a history of obstructive lung disease, such as COPD (Chronic Obstructive Pulmonary Disease)?
What are examples of Long-Acting Beta Agonists (LABA) and Long-Acting Muscarinic Antagonists (LAMA)?
What are the treatment options for thrombocytopenia (low platelet count)?
What is the best topical cream for treating extensive tinea pedis (athlete's foot)?
What is the diagnostic workup for ovarian torsion?
What is the diagnosis for a 48-year-old female presenting with nasal congestion, rhinorrhea, and cough, with symptoms progressing from a scratchy sore throat to thick yellow nasal drainage, and a possible fever, after her husband was diagnosed with a viral respiratory illness (VRI)?
What is the target blood pressure for someone taking antihypertensive (high blood pressure) medications?
What is the relationship between alcohol consumption and the development of hypertension (high blood pressure)?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question