Maintenance therapy in COPD: time to phase out ICS and switch to the new LAMA/LABA inhalers?

Abstract

Syed Mohammad Tariq,1 Enson C Thomas2 1Department of Respiratory Medicine, Luton and Dunstable University Hospital, Luton, 2Respiratory Unit, Bedford Hospital, Bedford, UK Abstract: Long-term maintenance therapy for COPD is evolving rapidly. Dual bronchodilation with new long-acting muscarinic antagonist and long-acting beta-agonist (LAMA/LABA) fixed dose combination inhalers were introduced over the past 2 years. In clinical trials, these inhalers significantly improved lung function (trough forced expiratory volume in 1 second), patient-reported outcomes, and quality of life measures compared with placebo, their respective monocomponents, and tiotropium. The recorded adverse events of these new inhalers were also similar to those of their monocomponents or placebo. There are concerns regarding long-term complications (weight gain, osteoporosis, cataract) and increased risk of community-acquired pneumonia with the use of inhaled corticosteroids (ICS). The new LAMA/LABA inhalers could potentially reduce the use of ICS as part and parcel of maintenance therapy in COPD. Recent studies compared these LAMA/LABA inhalers with ICS/LABA combination inhalers in moderate-to-severe COPD. The results are promising and favor the LAMA/LABA inhalers, especially in the longer duration trials. Furthermore, there is a clearer picture emerging as to the subgroup of COPD patients who may be able to successfully switch from their current ICS/LABA therapy to these new LAMA/LABA inhalers. Keywords: COPD, dual bronchodilation, exacerbations, inhaled corticosteroid, long-acting beta-agonist, long-acting muscarinic antagonist

Keywords

• COPD
• dual bronchodilation
• exacerbations
• inhaled corticosteroid
• long-acting beta-agonist
• long-acting muscarinic antagonist