New combination bronchodilators for chronic obstructive pulmonary disease: current evidence and future perspectives.

Fixed dose combination ( FDC) dual bronchodilators that co-administer a long acting β2-adrenoceptor agonist ( LABA) and a long acting muscarinic antagonist ( LAMA) are a new class of inhaled treatment for chronic obstructive pulmonary disease ( COPD). This review focuses on the clinical evidence for the benefit of LABA/ LAMA FDCs compared with monocomponent treatments, and also compared with active comparators that are widely used for the treatment of COPD, namely tiotropium and salmeterol-fluticasone. Novel FDC dual bronchodilators include QVA149 and umeclidinium/vilanterol ( UMEC/ VI). Long term clinical trials show that QVA149 and UMEC/ VI are superior to monocomponent therapy in terms of trough forced expiratory volume in 1 s ( FEV1), although the FEV1 improvement was limited to approximately 80-90% of the added monocomponent values. This suggests that the effect of combining a LABA and a LAMA is not fully additive. LABA/ LAMA FDC were associated with the largest mean changes in symptoms and health status that were above the minimal clinically important difference, in contrast to the monocomponents. Furthermore, these LABA/ LAMA FDCs demonstrated superiority over the active comparators tiotropium and salmeterol-fluticasone in terms of trough FEV1 and patient-reported outcomes. LABA/ LAMA FDCs offer a simplified means of maximizing bronchodilation for COPD patients, with the improvements in lung function being mirrored by benefits in terms of symptoms and exacerbations. The use of LABA/ LAMA FDCs in clinical practice is set to grow and further studies are needed to define their optimal place in treatment guidelines. [ABSTRACT FROM AUTHOR]