Abstract
Chronic obstructive pulmonary disease (COPD) is a common disabling disease characterized by progressive airflow obstruction. Great efforts were spent in the development of drugs able to improve symptoms, quality of life, reduce exacerbations, hospitalizations and the frequency of death of patients with COPD. The cornerstones of treatment are bronchodilator drugs of two different classes: beta agonists and muscarinic antagonists. Currently the Global initiative for COPD suggests the use of long acting beta agonists (LABAs) and long acting muscarinic antagonists (LAMAs) in combination for the majority of COPD patients, thus great interest is associated with the developing of LAMA/LABA fixed combination in the maintenance treatment of stable COPD. Many LAMA/LABA fixed dose combinations have been licensed in different countries and the clinical use of these drugs stimulated the performance of many clinical trials. The purpose of this review is a complete criticism of pharmacological and clinical aspects related to the use of LAMA/LABA single inhalers for the maintenance treatment of stable COPD, with particular mention to the most debated topics and future prospects in the field.
Highlights
Chronic obstructive pulmonary disease (COPD) is believed to be the third leading cause of death worldwide by 2020 (WHO, 2008).Chronic obstructive pulmonary diseases is a common disease characterized by respiratory symptoms and progressive airflow obstruction due to alveolar and bronchial abnormalities and inflammation caused by exposition to noxious substances (Global initiative for chronic obstructive Lung disease [Global initiative for COPD (GOLD)], 2018)
The results showed that the combination of TIO plus formoterol fumarate (FF) showed a faster onset of bronchodilator response (p < 0.01 for FEV1 and forced vital capacity FVC), a greater mean maximum change in FEV1 (p = 0.01) and FVC (p = 0.008) and greater AUC0–24 h values for FEV1, FVC and inspiratory capacity (IC) compared with TIO alone
PMDIs require the user to coordinate pressing down the canister and inhaling the medication while dry powder inhaler (DPI) are activated by breath; the inspiratory flow rate is a disadvantage of DPIs
Summary
Chronic obstructive pulmonary disease (COPD) is believed to be the third leading cause of death worldwide by 2020 (WHO, 2008). COPD is a disabling disease with huge impact on normal daily activities and limiting quality of life, the disease abruptly worsen due to exacerbations inducing a step down of health conditions, following which the recovery of breath function and activities is gradually slower and more difficult leading to disability and death (Global initiative for chronic obstructive Lung disease [GOLD], 2018). Global initiative for COPD suggests the use of long acting beta agonists (LABA) and long acting muscarinic antagonists (LAMA) in combination for group B patients with persistent symptoms, group C patients with further exacerbations on LAMA treatment and for group D patients with or without the addition of inhaled corticosteroids (ICSs). Ultra-LABA are ultra-long acting and are dosed once a day such as indacaterol (IND), olodaterol (OLO), and vilanterol (VIL); they provides both the quick bronchodilation effect
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