Available LABA-LAMA Combination Inhalers
LABA-LAMA combination inhalers are dual bronchodilator therapies that combine a long-acting beta-agonist with a long-acting muscarinic antagonist in a single device for COPD management.
Currently Available Fixed-Dose LABA-LAMA Combinations
The following LABA-LAMA combination inhalers are approved and available:
FDA-Approved Combinations
- Umeclidinium/Vilanterol (Anoro Ellipta) - combines umeclidinium (LAMA) with vilanterol (LABA) for once-daily maintenance treatment of COPD 1
European and International Combinations
- Indacaterol/Glycopyrronium - approved in Europe and multiple international markets 2
- Aclidinium/Formoterol - approved in Europe and numerous locations outside the United States 2
- Glycopyrronium/Formoterol - available as part of triple therapy formulations 3
Clinical Context for LABA-LAMA Use
LABA-LAMA dual bronchodilator therapy is strongly recommended over monotherapy for patients with moderate to severe dyspnea or reduced health status 4. The combination leverages different pathways to induce bronchodilation using submaximal drug doses, increasing benefits while minimizing receptor-specific side effects 2.
Guideline-Recommended Indications
- GOLD Group B patients (high symptoms, low exacerbation risk): LABA-LAMA is an appropriate first-line option 4
- Patients with persistent breathlessness despite LAMA or LABA monotherapy 4
- GOLD stage 2 and higher with dyspnea during usual activities despite single long-acting bronchodilator 4
- Patients with dyspnea or exercise intolerance: American Thoracic Society strongly recommends LABA-LAMA over monotherapy 5
Comparative Effectiveness
LABA-LAMA combinations demonstrate superior outcomes compared to monotherapy:
- Improved lung function and symptom control versus either LAMA or LABA alone 4, 2
- Reduced exacerbation rates compared to monotherapy 4
- Greater exacerbation reduction than ICS/LABA combinations 4
Important Clinical Considerations
LABA-LAMA is not indicated for acute bronchospasm relief or asthma treatment 1. These combinations are maintenance therapies requiring daily administration regardless of symptoms 2.
When to Escalate Beyond LABA-LAMA
If patients remain at high risk of exacerbations (≥2 moderate or ≥1 severe exacerbation per year) despite LABA-LAMA therapy, single-inhaler triple therapy (LAMA/LABA/ICS) is recommended due to proven mortality reduction benefits 4, 3.
The addition of ICS to LABA-LAMA should be reserved for patients with frequent/severe exacerbations and high blood eosinophil counts, or those with concomitant asthma 6.