LABA/LAMA as First-Line Therapy for COPD: A Summary of the Evidence and Guideline Recommendations

Abstract

Inhaled bronchodilators (alone or in combination) are the cornerstone of treatment for symptomatic patients with COPD, either as initial/first-line treatment or for second-line treatment escalation in patients who experience persistent symptoms or exacerbations on monotherapy. The Global Initiative for Chronic Obstructive Lung Disease 2022 report recommends initial pharmacological treatment with a long-acting muscarinic antagonist (LAMA) or a long-acting β2-agonist (LABA) as monotherapy for most patients, or dual bronchodilator therapy (LABA/LAMA) in patients with more severe symptoms, regardless of exacerbation history. The recommendations for LABA/LAMA are broader in the American Thoracic Society treatment guidelines, which strongly recommend LABA/LAMA combination therapy over LAMA or LABA monotherapy in patients with COPD and dyspnea or exercise intolerance. However, despite consistent guideline recommendations, real-world prescribing data indicate that LAMA and/or LABA without an inhaled corticosteroid are not the most widely prescribed therapies in COPD. This article reviews global and regional/national guideline recommendations for the use of LABA/LAMA in COPD, examines the evidence for the effectiveness and safety of LABA/LAMA versus other therapies and offers a practical guide for clinicians to help ensure appropriate use of LABA/LAMA therapy.

Development and validation of a model for predicting the early occurrence of RF in ICU-admitted AECOPD patients: a retrospective analysis based on the MIMIC-IV database

“…Bronchodilators are among the main measures to control symptoms in AECOPD [22]. The use of bronchodilators can improve respiratory symptoms, reduce the risk of deterioration, increase exercise tolerance, and improve quality of life in patients [23]. Our study indicated that the non-use of bronchodilators after admission was a risk factor for the occurrence of RF in AECOPD patients.…”

Stepwise management of COPD: What is next after bronchodilation?

“…11,12 Largely, the recommendations are aligned between GOLD, ATS, Germany, Spain, and Japan, as well as between guidelines from many other countries or regions. 1,7,9,11,[13][14][15][16][17] For example, the ATS practical guidelines strongly recommend that any patient with dyspnoea and exercise intolerance should be given LABA/LAMA as first-line therapy. 10 It is important to acknowledge that guideline recommendations always refer to classes of drugs rather than specific LAMA, LABA, or ICS molecules (and their combinations) within each class.…”

“…Largely, the recommendations are aligned between GOLD, ATS, Germany, Spain, and Japan, as well as between guidelines from many other countries or regions. 1,7,9,11,13–17 For example, the ATS practical guidelines strongly recommend that any patient with dyspnoea and exercise intolerance should be given LABA/LAMA as first-line therapy. 10…”

Clinical Concepts for Triple Therapy Use in Patients with COPD: A Delphi Consensus

“…1 Bronchodilator therapy with long-acting muscarinic antagonist (LAMA) and/or long-acting β2-agonist (LABA) is the recommended initial treatment regimen for COPD management. 1 , 2 However, for certain patients with COPD who are at a higher risk of exacerbation while on dual bronchodilator therapy, triple therapy with an inhaled corticosteroid (ICS), LAMA, and LABA is recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). 1 Similarly, the Spanish chronic obstructive pulmonary disease guidelines (GesEPOC) 2021 recommend using triple therapy in high-risk patients whose exacerbations are not controlled with dual bronchodilator or ICS/LABA combination and with blood eosinophils ≥100 cells/µL.…”