Long-acting bronchodilator (LABA plus LAMA) dual therapy for COPD

In patients who remain symptomatic or have continued exacerbations despite monotherapy with a long-acting beta2 agonist (LABA) or a long-acting muscarinic antagonist (LAMA), start combination LABA and LAMA therapy (long-acting bronchodilator dual therapy).

Long-acting bronchodilator dual therapy:

  • improves lung function and quality of life compared with LAMA or LABA monotherapy
  • reduces exacerbations compared with LABA monotherapy, and may reduce exacerbations compared with LAMA monotherapy
  • appears to reduce the frequency of exacerbations compared to combination therapy with an inhaled corticosteroid (ICS) and a LABA.

Long-acting bronchodilator dual therapy can be given as two single-drug inhalers using the doses outlined in Long-acting bronchodilator monotherapy.

Alternatively, a fixed-dose combination inhaler can be used. 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 a fixed-dose combination inhaler containing a LABA and a LAMA, use:

1 formoterol+aclidinium 12+340 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 formoterol + aclidinium    

OR

1 indacaterol+glycopyrronium 110+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 indacaterol + glycopyrronium    

OR

1 olodaterol+tiotropium 5+5 micrograms by inhalation via mist inhaler, daily (see Inhalers available in Australia for COPD for regimen expressed as number of inhalations) chronic obstructive pulmonary disease, maintenance olodaterol + tiotropium olodaterol+tiotropium olodaterol+tiotropium

OR

1 vilanterol+umeclidinium 25+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 vilanterol + umeclidinium vilanterol+umeclidinium vilanterol+umeclidinium

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 LABA, LAMA and inhaled corticosteroid triple therapy, also consider other causes of breathlessness.