SOURCE: Calzetta L, Rogliani P, Matera MG, et al. A systematic review with meta-analysis of dual bronchodilation with LAMA/LABA for the treatment of stable COPD. Chest 2016;149:1181-1196.

There has been some suggestion that the bronchodilation afforded by anticholinergic agents, commonly referred to as long-acting antimuscarinic agents (LAMA, e.g., tiotropium, umeclidinium) is at least as good as that provided by long-acting beta-agonists (LABA, e.g., salmeterol, formoterol). Additionally, there does not appear to be any tachyphylaxis associated with LAMA as has been seen with LABA. Since most patients with COPD experience disease progression, pharmacologic augmentation is the rule rather than the exception. Only recently have LAMA/LABA combinations become available. Is LAMA + LABA really better than either alone? And if so, is there a best LAMA/LABA combination?

Calzetta et al performed a systematic review and meta-analysis of controlled trials (n = 23,168) that addressed LAMA/LABA combination treatment compared to individual component (LAMA or LABA) monotherapy. As measured by trough FEV1, dyspnea indices, and the St. George’s Respiratory Questionnaire scores, LAMA/LABA consistently outperformed either monotherapy. Although there are a variety of different LAMA/LABA combinations, no particular combination emerged as distinctly superior. Combining LAMA with LABA provides meaningfully better symptomatic improvement than either agent alone.