These studies were published from 2002 to 2018 and their characteristics are summarized in Table 1 and additional file: Table S2. D'Urzo A, Rennard S, Kerwin E, Donohue JF, Lei A, Molins E, et al. Chest. Compared to LABA, there was a small but significant increase in the trough FEV1 with LAMA treatment (mean difference 0.02, 95% CI 0.01 to 0.03, P = 0.0006, I2 = 48%: Fig. Donohue JF, Maleki-Yazdi MR, Kilbride S, Mehta R, Kalberg C, Church A. Efficacy and safety of once-daily umeclidinium/vilanterol 62.5/25 mcg in COPD. Breo Ellipta, Brand names:  In St George’s Respiratory Questionnaire and transitional dyspnoea index score, there were no differences between LABA and LAMA treatment. Prescribing Information, Brand name:  Vogelmeier C, Kardos P, Harari S, Gans SJ, Stenglein S, Thirlwell J. Formoterol mono- and combination therapy with tiotropium in patients with COPD: a 6-month study. Springer Nature. 2011 and Decramer, et al. Concerning the higher incidence of hypertension with LABA, this could be explained as a beta-agonist related adverse effect [47]. The included outcomes of interest in the current study were as follow: i) exacerbations (number of patients experiencing one or more exacerbations), ii) St George’s Respiratory Questionnaire (SGRQ) score change from the baseline, iii) transitional dysponea index (TDI) score change from the baseline, iv) trough forced expiratory volume in one second (FEV1) change from the baseline, and v) adverse events (total adverse events and serious adverse events). Triple therapy versus single and dual long-acting bronchodilator therapy in COPD: a systematic review and meta-analysis. 2011;38:797–803. Andreas S, Bothner U, Trampisch M, Haensel M, Buhl R, Alter P. Effect of long-acting β2-agonists olodaterol and formoterol on heart rate and blood pressure in chronic obstructive pulmonary disease patients. tiotropium 2.5mcg. The others are aclidinium bromide and glycopyrronium bromide. These reviews have shown that LAMA is superior to LABA in reducing the risk of exacerbations with fewer adverse events, but not in the SGRQ and TDI score and trough FEV1. Minimal clinically important differences in COPD lung function. glucocorticoids, For professionals: Compared to non-Indacaterol LABA treatment, indacaterol showed a higher incidence of cough, but not of COPD-related adverse events, than LAMA (OR 0.59, 95% CI 0.46 to 0.75; P < 0.0001; I2 = 7%, additional file: Fig.S9A, S9B). In the subgroup analysis, there were significant increases in the trough FEV1 with LAMA compared with LABA treatment when comparing tiotropium to salmeterol in three studies (mean difference 0.03, 95% CI 0.02 to 0.04; P < 0.00001; I2 = 0%; additional file: Fig. The details of adverse events were evaluated in 13 studies with frequency threshold for reporting at from 1.5 to 5%. 2014;145:981–91. In the SGRQ score, we firstly demonstrated that formoterol was more effective than glycopyrronium. Subanalysis for adverse events (Indacaterol vs non-Indacaterol). Cochrane Database Syst Rev. However, there were no differences in the incidence of exacerbations between any other drugs, which were not administered to patients with a history of exacerbations. Third, we did not evaluate the physical activity including exercise performance, which is one of the important therapeutic targets in COPD patients, due to the lack of a trial that met our selection criteria. The superiority was also shown in the subgroup analysis when comparing not only tiotropium to salmeterol or olodaterol, but also umeclidinium to vilanterol. These results are inconsistent with the inferiority of LABA to LAMA in the trough FEV1 in the current results [44, 45], but these discrepancies might be explained by the earlier or higher peak bronchodilatory effect of LABA compared to LAMA in the comparison between these drugs [16, 26, 33, 34]. Next, full text assessments were performed to identify the studies for inclusion, and the data were retrieved from the eligible studies. A subgroup analysis was performed in each drug included in the LABA and LAMA group and major adverse events. Cazzola M, Rogliani P, Calzetta L, Matera MG. The mean change in the SGRQ score was not statistically different between LABA and LAMA (mean difference 0.23, 95% CI: − 0.45 to 0.92, P = 0.50, I2 = 50%; Fig. Chronic obstructive pulmonary disease (COPD) is currently the third leading cause of death in the world [1]. Lancet. Maltais F, Singh S, Donald AC, Crater G, Church A, Goh AH, et al. Compared to LABA, there was a small but significant increase in the trough FEV1 after LAMA treatment (Mean difference 0.02, 95% CI 0.01 to 0.03, P = 0.0006). Trelegy Ellipta ® (fluticasone furoate/ umeclidinium bromide/ vilanterol trifenatate) 100/62.5/25 mcg/dose. Privacy In stable COPD patients susceptible to exacerbations, LAMA or LABA inhaled monotherapy can be used to prevent moderate to severe exacerbations (1.1) LABA or LAMA are superior to SABD. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 2017;125:39–48. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Singh D, Jones PW, Bateman ED, Korn S, Serra C, Molins E, et al. CAS  2004;23:832–40. Analysis of chronic obstructive pulmonary disease exacerbations with the dual bronchodilator QVA149 compared with glycopyrronium and tiotropium (SPARK): a randomised, double-blind, parallel-group study. 4). Cochrane Central Register of Controlled Trials, Global Initiative for Chronic Obstructive Lung Disease, Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Generic albuterol is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. S5). Ther Adv Respir Dis. The total adverse events were 6370 (N = 12,830) with LAMA and 5884 (N = 11,770) with LABA treatment (Fig. Generic name: budesonide / formoterol systemic, Drug class: This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. glycopyrronium 50mcg. Dual bronchodilation with QVA149 versus single bronchodilator therapy: the SHINE study. adrenergic bronchodilators, Brand name:  The actual difference of 10 to 30 mL is very small and below the 50 to 100 mL level of minimal clinically important difference for which the index is usually used for a comparison with placebo [40,41,42]. 3). Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective.To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discu… We searched and identified randomized controlled trials in MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Pubmed and EMBASE databases on November 2018, using the search strategy provided in the on-line supplement. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. US Pharm. Thirteen studies with 14,610 participants were included for evaluation of the SGRQ score. In trough FEV1, we firstly demonstrated the superiority of LAMA treatment to LABA. Only in lower respiratory tract infection and hypertension with an incidence of less than 4% was the frequency significantly lower with LAMA than that with LABA treatment (lower respiratory tract infection: OR 0.62, 95% CI 0.39 to 0.98; P = 0.04; I2 = 29%; hypertension: OR 0.67, 95% CI 0.52 to 0.86; P = 0.002; I2 = 2%, additional file: Table S5 and Fig.S8A, S8B). Chest. Currently available LAMA comprises tiotropium, glycopyrronium, aclidinium and umeclidinium and LABA includes salmeterol, formoterol, indacaterol, vilanterol and olodaterol. In fact, in our current analysis, at a lower concentration (55 or 75 μg) of indacaterol, there was no difference in the total adverse events between indacaterol and glycopyrrolate [30, 31]. statement and Effects of a combination of umeclidinium/vilanterol on exercise endurance in patients with chronic obstructive pulmonary disease: two randomized, double-blind clinical trials. 2016 Jun;10(3):289; PMID: 27255756]. Buhl R, Dunn LJ, Disdier C, Lassen C, Amos C, Henley M, et al. Treatment from your doctor is just one part of COPD care. In the current systematic review, the early or peak bronchodilatory effect was out of scope because of the small amount of uniform data. Blinded 12-week comparison of once-daily indacaterol and tiotropium in COPD. Open labeled-tiotropium groups and unblinded studies were excluded from the analysis. In the latest review, Chen, et al. Inhalers are the mainstay of treatment for COPD. Table S4. Concerning the TDI score, thirteen studies with 15,911 participants were evaluated, and the mean TDI score change from the baseline was 1.4 ± 3.8 (SD) with LAMA (N = 8454) and 1.5 ± 3.9 (SD) with LABA treatment (N = 7457) (Fig. 2015;10:e0119948. We also conducted a search of ClinicalTrials.gov (www.ClinicalTrials.gov). 2012;32:456–74. Symbicort, For professionals: Details of adverse events (%). O'Donnell DE, Fluge T, Gerken F, Hamilton A, Webb K, Aguilaniu B, et al. Chest. In 2012, Chong, et al. Correlations between FEV1 and patient-reported outcomes: a pooled analysis of 23 clinical trials in patients with chronic obstructive pulmonary disease. Pulm Pharmacol Ther. Types of bronchodilators for COPD include both short and long-acting beta-agonists, anticholinergics, theophylline, and combination medications. However, it is still unclear whether LABA or LAMA should be used for the initial treatment. Newer information suggests that for some people, the LAMAs may also help prevent flare ups or exacerbations. Figure S8 Subanalysis for adverse events. Quality of evidence was measured in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE), and absolute estimates of effect for the outcomes were also evaluated [15]. 2014;19:403–10. In our current results of the SGRQ and TDI score, there were no significant differences between LABA and LAMA treatment. They demonstrated that there were no differences in trough FEV1 and SGRQ scores between LABA and LAMA treatment, but indacaterol showed higher incidences of cough and worsening of COPD in the adverse events than tiotropium [12]. The overall quality of evidence was moderate for all outcomes (additional file: Table S6). Stiolto Respimat, Brand name:  Pharmacotherapy. Li C, Cheng W, Guo J, Guan W. Relationship of inhaled long-acting bronchodilators with cardiovascular outcomes among patients with stable COPD: a meta-analysis and systematic review of 43 randomized trials. Concerning the safety components, our current analysis showed a small but significantly lower incidence of total adverse events in LAMA compared to LABA. However, in the subgroup analysis, indacaterol was significantly superior to tiotropium in the TDI score, which is consistent with a previous result [11]. As the air sacs in your lung get larger, your lung can fill with too much air every time … Abuse may lead to moderate or low physical dependence or high psychological dependence. Watz H, Krippner F, Kirsten A, Magnussen H, Vogelmeier C. Indacaterol improves lung hyperinflation and physical activity in patients with moderate chronic obstructive pulmonary disease--a randomized, multicenter, double-blind, placebo-controlled study.

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