Long-acting bronchodilator (LABA or LAMA) monotherapy for COPD
Long-acting bronchodilator monotherapy (plus as-required short-acting bronchodilator used as ‘rescue medication’) is indicated for patients who remain symptomatic despite general measures and short-acting bronchodilator therapy.
Long-acting bronchodilators include:
- long-acting muscarinic antagonists (LAMAs): aclidinium, glycopyrronium, tiotropium, umeclidinium
- long-acting beta2 agonists (LABAs)1: indacaterol, formoterol, olodaterol, salmeterol, vilanterol.
Long-acting bronchodilators improve lung function (as measured by forced expiratory volume in 1 second [FEV1]). They also provide symptomatic relief of breathlessness, improve exercise capacity, reduce the frequency and severity of exacerbations, reduce hospitalisations and improve quality of life. Symptomatic and functional benefits should be seen within 6 to 12 weeks, and can occur even in the absence of any change in FEV1.
In a meta-analysis of randomised controlled trials, LAMAs were more effective at reducing exacerbations than LABAs2. However, individual response to long-acting bronchodilators varies; some patients may respond better to a LABA than a LAMA.
The choice of long-acting bronchodilator therapy should also consider patient preference of dosage regimen and device—see Inhalers available in Australia for COPD for details of inhaled drug formulations for COPD, and Summary of inhalational drug delivery devices for information about devices.
For treatment with a LAMA, use:
1 aclidinium 322 micrograms by inhalation via DPI, twice daily (see Inhalers available in Australia for COPD for regimen expressed as number of inhalations) chronic obstructive pulmonary disease, maintenance aclidinium
OR
1 glycopyrronium 50 micrograms by inhalation via DPI, daily (see Inhalers available in Australia for COPD for regimen expressed as number of inhalations) chronic obstructive pulmonary disease, maintenance glycopyrronium (glycopyrrolate) glycopyrronium (glycopyrrolate) glycopyrronium (glycopyrrolate)
OR
1 tiotropium 13 or 18 micrograms3 by inhalation via DPI, daily (see Inhalers available in Australia for COPD for regimen expressed as number of inhalations) chronic obstructive pulmonary disease, maintenance tiotropium
OR
1 tiotropium 5 micrograms by inhalation via mist inhaler, daily (see Inhalers available in Australia for COPD for regimen expressed as number of inhalations) tiotropium
OR
1 umeclidinium 62.5 micrograms by inhalation via DPI, daily (see Inhalers available in Australia for COPD for regimen expressed as number of inhalations). chronic obstructive pulmonary disease, maintenance umeclidinium
For treatment with a LABA, use:
indacaterol 150 micrograms by inhalation via DPI, daily4, increasing to 300 micrograms daily if required (see Inhalers available in Australia for COPD for regimen expressed as number of inhalations). chronic obstructive pulmonary disease, maintenance indacaterol
Assess response 3 to 6 months after starting treatment. In patients who remain symptomatic or have continued exacerbations, check inhaler technique and adherence. Before stepping up to long-acting bronchodilator dual therapy, also consider other causes of breathlessness, particularly in patients who show no response to a long-acting bronchodilator.