![]() ![]() The LABA/LAMA combination was better than LABA/ICS combination, especially in people with a prior episode of flare-ups. Combination inhalers (LABA/LAMA and LABA/ICS), are more effective for controlling symptoms than single-agent therapies (LAMA and LABA), in general. The LABA/LAMA combination was the best treatment, followed by LAMA, in preventing flare-ups although there was some uncertainty in the results. We collected and analysed data from 99 studies, including a total of 101,311 participants with advanced COPD, using a special method called network meta-analysis, which enabled us to simultaneously compare the four inhaler groups and 28 individual inhalers (4 LABAs, 5 LAMAs, 9 LABA/ICS combinations, and 10 LABA/LAMA combinations). Preventing severe flare-ups and hospital admissions is especially important to people with COPD, healthcare providers, policy makers and society. There are not many head-to-head comparisons to determine which treatment group or individual inhaler is better compared to the others. Combination inhalers are usually reserved for individuals whose single-maintenance inhaler, such as LAMA or LABA fails. The long-acting inhalers are usually reserved for more advanced COPD.ĭoes it matter which long-acting inhaler is used in people with advanced COPD?Ĭommonly used maintenance inhalers are grouped into four different groups: long-acting beta2-agonists (LABAs) long-acting muscarinic antagonists (LAMAs) LABA/inhaled corticosteroid (ICS) combinations and LABA/LAMA combinations. A rescue inhaler is short- and fast-acting, and used as needed for quick relief of symptoms, whereas a maintenance inhaler is long-acting and used on a daily basis to relieve daily symptoms and reduce flare-ups. There are two types of inhalers for COPD: rescue and maintenance. COPD damages the lungs and causes airways to narrow which makes it difficult to breathe. So if you can relieve that early, why go halfway? Let's go the full way with this, and do the best we can for these patients.What is COPD and why does a doctor prescribe an inhaler?Ĭhronic obstructive lung disease (COPD) is usually caused by smoking or other airway irritants. ![]() The dyspnea clearly relates to airflow obstruction and hyperinflation. So essentially, you're getting more benefit with very little difference in safety, and so why not? A lot of COPD patients are very limited and dyspnea is their major complaint, major symptom. The baseline drugs are safe enough and giving the 2 together doesn't seem to really have an impact on the safety. And what's interesting is what the data is showing with these LAMA/LABA combinations is that in terms of safety, there's not much of a change or difference from the single-agent safety. There may be some additional benefit of giving the 2 together, in terms of interactions that may be beneficial. ![]() So giving the 2 agents together in 1 device, you know it ensures that they will comply, that they will take both the medications. So I think because of that, achieving the bronchodilation is very important. So, combining them gives you more bronchodilation, and so that's of course the one big advantage-bronchodilation relates to their ability, to their exercise capacity and may also relate to a lot of other outcomes, like health status and quality of life. And we're getting levels of bronchodilation that we could not achieve with 1 of those agents. So when you combine the 2, you generally always tend to get more bronchodilation. Sethi: So basically what's happened is that the LAMA/LABA act by different mechanisms-and they’re complementary mechanisms. MD Mag: What is the currently understood benefit of LAMA/LABA in COPD? ![]() There are other LAMA/LABA combinations available, but this has got a different device, and therefore we have more choices now in terms of delivery and drugs for our patients with COPD. It's given by the inhaled route, it's given twice a day, and it's got a different device. So, there's a combination that has not become available to use in patients with COPD for the maintenance treatment of COPD. Sethi: So we have the introduction of a LAMA/LABA combination-aclidinium bromide is the LAMA, and formoterol fumarate muscarinic agent is the LABA. ![]()
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