Fixed-Dose Combination Inhalers

Abstract

In asthma and chronic obstructive pulmonary disease (COPD), an important step in simplifying management and improving adherence with prescribed therapy is to reduce the dose frequency to the minimum necessary to maintain disease control. Fixed-dose combination (FDC) therapy might enhance compliance by decreasing the number of medications and/or the number of daily doses. Furthermore, they have the potential for enhancing, sensitizing, and prolonging the effects of monocomponents. Combination therapy with an inhaled corticosteroid (ICS) and a long-acting β-agonist (LABA) is considered an important approach for treating patients with asthma and patients with severe COPD who have frequent exacerbations. Several ICS/LABA FDCs are now commercially available or will become available within the next few years for the treatment of COPD and/or asthma. Several studies demonstrate that there are a number of added benefits in using combinations of β-agonists and antimuscarinic agents. In particular, LABA/long-acting antimuscarinic agent (LAMA) combination seems to play an important role in optimizing bronchodilation. Several once-daily and twice-daily LABA/LAMA FDCs have been developed or are in clinical development. LAMA/ICS FDCs seem to be useful in COPD and mainly in asthma, in patients with severe asthma and persistent airflow limitation. The rationale behind the ICS/LABA/LAMA FDCs seems logical because all three agents work via different mechanisms on different targets, potentially allowing for lower doses of the individual agents to be used, accompanied by improved side effect profiles. In effect, in clinical practice, concomitant use of all three compounds is common, especially in more severe COPD but also in the treatment of adults with poorly controlled asthma despite maintenance treatment with high-dose ICS and a LABA.

Current unmet needs and potential solutions to uncontrolled asthma

“…Training that includes visual aids could reinforce correct inhaler technique [2,90]. Inhaled devices that are intuitive and minimise critical errors, as well as simplifying treatment regimens to once-daily fixed-dose combination inhalers may also facilitate successful dosing, adherence and asthma control [91,92].…”

Novel Fluticasone Propionate and Salmeterol Fixed-Dose Combination Nano-Encapsulated Particles Using Polyamide Based on L-Lysine

“…Further, FDCs have the potential to improve and prolong the effect of monotherapy. In particular, the FDC of long-acting β2 agonist (LABA) and inhaled corticosteroid (ICS) is considered as a key approach for the management of asthma and patients with severe chronic obstructive pulmonary disease (COPD), particularly those experiencing exacerbations [ 2 , 3 , 4 , 5 ]. The National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group updated the Asthma Management Guidelines in 2020.…”

<p>Impact of Single Combination Inhaler versus Multiple Inhalers to Deliver the Same Medications for Patients with Asthma or COPD: A Systematic Literature Review</p>

“…11 The advent of singleinhaler combination therapies, which provide twoor, for COPD, up to threetreatments, has therefore been welcomed as a method by which we can simplify the management of asthma and COPD while increasing adherence to prescribed treatments, when compared with the use of multiple separate devices. 12 While evidence of the advantages of single inhalers containing multiple drugs over single-inhaler monotherapy is widespread, 13,14 less is known of comparisons between single inhalers and the equivalent combination taken using multiple inhalers. Because single-inhaler therapies offer the potential advantage of being easier for patients to use, other outcomesincluding treatment adherence, cost-effectiveness, and health-related quality of life (HRQoL)are also of particular interest when comparing them with the equivalent treatment via multiple inhalers.…”