Brand Name LABAs and LAMAs
The most commonly prescribed brand name LABAs include Serevent (salmeterol) and Foradil (formoterol) for 12-hour formulations, while LAMAs include Spiriva (tiotropium) as the most established agent. 1
Long-Acting Beta Agonists (LABAs)
12-Hour Acting Formulations
- Salmeterol is available as Serevent and has been extensively studied in both asthma and COPD management 1
- Formoterol is marketed as Foradil and Perforomist, providing 12-hour bronchodilation 1
24-Hour Acting Formulations
- Indacaterol represents the newer generation of once-daily LABAs, though specific brand names vary by region 1
Key Clinical Considerations
- LABAs significantly improve lung function, dyspnea, and health status while reducing exacerbation rates 1, 2
- LABAs should never be used as monotherapy for asthma - they must be combined with inhaled corticosteroids to prevent serious adverse events 1
- For COPD, LAMAs demonstrate superior exacerbation reduction compared to LABAs when used as monotherapy 1
Long-Acting Muscarinic Antagonists (LAMAs)
Available Brand Names
- Spiriva (tiotropium) is the most extensively studied LAMA with proven benefits in reducing exacerbations and hospitalizations 1
- Glycopyrrolate is available in various formulations including Seebri 1, 3
- Umeclidinium is marketed as Incruse Ellipta 3
Clinical Efficacy
- LAMAs improve symptoms, enhance pulmonary rehabilitation effectiveness, and reduce both exacerbations and related hospitalizations 1
- LAMAs have greater effect on exacerbation reduction compared to LABAs and decrease hospitalizations 1, 4
- All LAMAs provide similar clinical benefits in improving lung function, reducing dyspnea, and improving quality of life 4
Combination Products
LABA/ICS Combinations (Primarily for Asthma)
- These combinations are preferred over LABA monotherapy for asthma to prevent the risk of serious adverse events 1
- The combination prevents patients from substituting LABA for ICS if symptoms improve 5
LABA/LAMA Combinations (Primarily for COPD)
- Anoro Ellipta (umeclidinium/vilanterol) 62.5/25 µg once daily 3
- Stiolto Respimat (tiotropium/olodaterol) 5/5 µg once daily 3
- Utibron Neohaler (indacaterol/glycopyrrolate) 27.5/15.6 µg twice daily 3
- LABA/LAMA combinations increase lung function more than LAMA alone and reduce exacerbations compared to monotherapy 1, 3
Triple Therapy (ICS/LABA/LAMA)
- Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol) represents fixed-dose triple therapy 6
- Trimbow (beclomethasone dipropionate/formoterol/glycopyrronium) is an extrafine formulation triple therapy 6, 7
- Triple therapy improves lung function, symptoms, and health status while reducing exacerbations compared to dual therapy 1, 6
Important Safety Considerations
LABA-Specific Warnings
- Salmeterol monotherapy increases non-fatal serious adverse events (OR 1.14,95% CI 1.01-1.28) 5
- For asthma, LABAs must always be prescribed with ICS in a combination inhaler to ensure patients don't substitute LABA for corticosteroid therapy 1, 5
- Regular LABA use before exercise may disguise poorly controlled persistent asthma 1
Cost and Formulary Considerations
- Generic tiotropium should be considered first for initial LAMA therapy if available and affordable 4
- Insurance formularies often dictate which specific brand is most affordable for individual patients 4
- Manufacturer assistance programs may significantly reduce out-of-pocket costs 4
- Once-daily formulations may improve adherence compared to twice-daily dosing 2