What are the LAMA (Long-Acting Muscarinic Antagonist) medications for an adult patient with a history of respiratory issues, such as chronic obstructive pulmonary disease (COPD) and asthma?

LAMA (Long-Acting Muscarinic Antagonist) Medications

LAMAs are a class of inhaled bronchodilators that include tiotropium bromide, aclidinium bromide, glycopyrronium bromide (also called glycopyrrolate), and umeclidinium bromide, all approved for maintenance treatment of COPD. 1, 2, 3, 4

Currently Available LAMA Medications

The following LAMAs are FDA-approved and available for clinical use:

• Tiotropium bromide - Available as Spiriva (18 mcg once daily via HandiHaler or 2.5 mcg once daily via Respimat inhaler) 1, 4, 5

• Aclidinium bromide - Dosed at 400 mcg twice daily 3, 4, 6

• Glycopyrronium bromide (glycopyrrolate) - Also known as NVA237, dosed at 50 mcg once daily 3, 4, 6

• Umeclidinium bromide - Dosed once daily 2, 3, 4

Clinical Equivalence and Selection

All currently available LAMAs provide similar clinical benefits in improving lung function, reducing dyspnea, decreasing exacerbation risk, and improving quality of life. 7 Network meta-analyses demonstrate comparable efficacy between aclidinium 400 mcg twice daily, tiotropium 5 mcg once daily, tiotropium 18 mcg once daily, and glycopyrronium 50 mcg once daily for trough FEV1, health-related quality of life (SGRQ scores), and dyspnea improvements (TDI scores) at 24 weeks. 6

Key Clinical Considerations

• LAMAs are recommended as first-line maintenance therapy for patients with moderate to severe COPD requiring regular bronchodilator therapy by GOLD guidelines 7

• LAMAs demonstrate superior exacerbation reduction compared to LABAs when evaluated collectively in meta-analyses 7

• The choice between specific LAMA agents can be based on dosing frequency preference (once daily vs. twice daily), delivery device, and individual patient response 3, 4

Combination Products

LAMAs are also available in fixed-dose combinations:

• LAMA/LABA combinations: Tiotropium/olodaterol, glycopyrronium/indacaterol, umeclidinium/vilanterol, and aclidinium/formoterol 1, 8

• Triple therapy (LAMA/LABA/ICS): Available as single-inhaler triple therapy for patients at high risk of exacerbations 9

Safety Profile

All LAMAs share similar anticholinergic precautions: use with caution in narrow-angle glaucoma and urinary retention (particularly prostatic hyperplasia or bladder-neck obstruction). 1, 2 Patients should be instructed to contact their physician immediately if symptoms of these conditions occur. 1, 2

The comparable proportion of adverse drug reactions across LAMAs ranges from 3.52% to 4.07% in real-world practice settings. 8