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Combination bronchodilator therapy in the management of chronic obstructive pulmonary disease

Donald P Tashkin1* and Gary T Ferguson2

Author Affiliations

1 Department of Medicine, David Geffen School of Medicine at UCLA, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA

2 Pulmonary Research Institute of Southeast Michigan, 28815 Eight Mile Road, Suite 103, Livonia, MI, 48152, USA

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Respiratory Research 2013, 14:49  doi:10.1186/1465-9921-14-49

Published: 8 May 2013


Chronic obstructive pulmonary disease (COPD) represents a significant cause of global morbidity and mortality, with a substantial economic impact. Recent changes in the Global initiative for chronic Obstructive Lung Disease (GOLD) guidance refined the classification of patients for treatment using a combination of spirometry, assessment of symptoms, and/or frequency of exacerbations. The aim of treatment remains to reduce existing symptoms while decreasing the risk of future adverse health events. Long-acting bronchodilators are the mainstay of therapy due to their proven efficacy. GOLD guidelines recommend combining long-acting bronchodilators with differing mechanisms of action if the control of COPD is insufficient with monotherapy, and recent years have seen growing interest in the additional benefits that combination of long-acting muscarinic antagonists (LAMAs), typified by tiotropium, with long-acting β2-agonists (LABAs), such as formoterol and salmeterol. Most studies have examined free combinations of currently available LAMAs and LABAs, broadly showing a benefit in terms of lung function and other patient-reported outcomes, although evidence is limited at present. Several once- or twice-daily fixed-dose LAMA/LABA combinations are under development, most involving newly developed monotherapy components. This review outlines the existing data for LAMA/LABA combinations in the treatment of COPD, summarizes the ongoing trials, and considers the evidence required to inform the role of LAMA/LABA combinations in treatment of this disease.

COPD; Combination therapy; Bronchodilation; Beta 2 agonist; Antimuscarinic