1 In contrast, GINA plans to add tiotropium, the only LAMA approved for the treatment of asthma, to ICS/LABA when the disease is not well controlled and before escalating to treatment with biologics or low-dose oral corticosteroids. GOLD recommends adding a LAMA to an ICS/LABA combination or an ICS to a LABA/LAMA combination, depending on the different clinical situations mainly related to the presence of dyspnoea or exacerbations, with the option to refer to blood eosinophil count. However, there is a substantial difference between the GOLD and GINA strategies. Strategy reports from both the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 1 and the Global Initiative for Asthma (GINA) 2019 2 highlight the importance of using the triple combination of inhaled corticosteroids (ICS), long-acting β 2-agonists (LABAs), and long-acting muscarinic receptor antagonists (LAMAs) in the treatment of chronic obstructive pulmonary disease (COPD) and asthma, respectively. KeywordsĪsthma, COPD, triple therapy, single-inhaler Article: However, there is a real risk that the use of single-inhaler triple therapy will expand the “one-size-fits-all” approach that has conditioned the prescriptive behavior of many doctors in the recent past, with little consideration of individual patient variability when making management decisions. Pivotal trials have shown that there is a role for triple therapy, mainly for single-inhaler triple therapy, in both COPD and asthma management. Three single-inhaler triple therapies-beclomethasone dipropionate/formoterol/glycopyrronium, fluticasone furoate/vilanterol/umeclidinium, and budesonide/glycopyrronium/formoterol - are available to treat COPD, whereas no single-inhaler triple therapy has yet been approved for use in asthma, but several trials have evaluated, or are exploring, this possibility. As there is well-documented evidence that triple therapy is effective in improving lung function and reducing the risk of exacerbation in patients with asthma and those with COPD, single-inhaler triple therapies have been developed mainly to increase adherence to treatment that often is low because of complexity introduced by the additional inhaler(s). “In this cohort study, LAMA-LABA therapy was associated with improved clinical outcomes compared with ICS-LABA therapy, suggesting that LAMA-LABA therapy should be preferred for patients with COPD,” the researchers concluded.A favorable pharmacological interaction between long-acting β 2 agonists, long-acting muscarinic receptor antagonists, and inhaled corticosteroids (ICSs) explains why triple therapy is effective both in chronic obstructive pulmonary disease (COPD) and asthma however, it has been documented that the presence of an ICS may cause the occurrence of pneumonia. The findings were robust across several subgroup analyses.
The primary outcome was defined as the first moderate or severe COPD exacerbation, and the primary safety outcome was first pneumonia hospitalization.Īccording to the results, LAMA-LABA use was associated with an 8% reduction in the rate of first moderate or severe COPD exacerbation compared with ICS-LABA use (HR=0.92 95% CI, 0.89-0.96), as well as a 20% reduction in the rate of pneumonia hospitalization (HR=0.80 95% CI, 0.75-0.86). Kesselheim, assessed 30,216 matched pairs of COPD patients who had a filled out a new prescription of ICS-LABAs or LAMA-LABAs between January 1, 2014, and December 31, 2019.
Combo inhalers lama laba trial#
The findings appeared this week in JAMA Internal Medicine.ĬOPD guidelines recommend LAMA-LABAs over ISC-LABAs however, clinical trial data, as the researchers noted, “have been conflicting and raised concerns of generalizability.” A new study suggests that patients with chronic obstructive pulmonary disease (COPD) should be treated with an inhaler combination containing long-acting muscarinic antagonists (LAMAs) and long-acting β-agonists (LABAs) instead of inhalers containing inhaled corticosteroids (ICSs) and LABAs.
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