We envisage providing a foundation for informed decision-making by respiratory physicians that would allow appropriate selection of the optimal bronchodilation therapy with LABA/LAMA FDCs for COPD patients. This review article provides an objective overview of the available inhaled LABA/LAMA fixed-dose combinations (FDCs) for the treatment of COPD with emphasis on the efficacy and safety of their monocomponents, particularly in the context of management of COPD patients from the Asian region. It is noteworthy that the global treatment guidelines for COPD do not recommend region-specific treatment options thus, regional guidelines such as those in Japan and Korea draw substantially from the global guidelines for treatment recommendations. Therefore, patients in groups B and D have potential for receiving LABA/LAMA combination therapy. Patients without a significant exacerbation history but with persistent symptoms on monotherapy (LAMA or LABA alone) are also eligible for LABA/LAMA combination therapy (GOLD group B). Moreover, combination inhaler therapy is recommended as the first-line therapy for symptomatic patients with at least two COPD exacerbations or one exacerbation requiring hospitalization in the past year (GOLD group D). Place of Bronchodilators in Guideline-Recommended Pharmacological Treatment of COPDīased on strong clinical evidence, the GOLD 2019 strategy recommends treatment with a LABA/LAMA combination for patients with stable COPD considering its superiority versus monotherapy or LABA/ICS, and its lower risk of pneumonia versus ICS-containing therapy. Differences in COPD prevalence and clinical management exist between Asian and global populations: smoke from biomass fuels and industrial toxins are major risk factors, apart from tobacco smoke rates of COPD-associated mortality and morbidity are higher in Asia differences in overall healthcare management structure and cultural differences. In Korea, the prevalence of COPD was found to be 13.4% in a survey population aged 40 years or more. The prevalence of COPD in Japan was reported to be 8.6% in a large epidemiological study. In Asia, the estimated COPD prevalence was 6.2%, with 19.1% of patients having severe COPD. COPD is currently the fourth leading cause of death worldwide the global burden of COPD is indicated by a prevalence of 251 million cases of this disease. Moreover, COPD exacerbations (acute worsening of the usual symptoms beyond normal day-to-day variation) impose a significant burden on patients due to increased morbidity and associated healthcare costs. This detailed overview of the efficacy and safety of LABA/LAMA FDCs in global and Asian COPD patients is envisaged to provide a better understanding of the benefits of these therapies and to inform healthcare providers and patients on their appropriate use.īurden of Chronic Obstructive Pulmonary DiseaseĬhronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the airways characterized by persistent symptoms, progressive breathlessness, and poorly reversible airflow obstruction, which ultimately lead to impaired quality of life in these patients. Special emphasis is placed on the clinical evidence for the monocomponents and LABA/LAMA FDCs from the Asian population. Additionally, in this review we describe the rationale behind the use of LABA/LAMA FDC therapy, key findings from the preclinical and clinical trial evaluation of respective LABA and LAMA monocomponents, and the efficacy and safety of LABA/LAMA FDCs. This review comprehensively describes the latest clinical evidence from key studies on the efficacy and safety of four approved LABA/LAMA fixed-dose combinations: indacaterol/glycopyrronium, vilanterol/umeclidinium, formoterol/aclidinium, and olodaterol/tiotropium. Fixed-dose combinations (FDCs) of LABA/LAMA are recommended for the majority of symptomatic COPD patients by global guidelines regional guidelines such as the Japanese and Korean guidelines also provide similar recommendations for the use of LABA/LAMA FDCs. Maintenance bronchodilator therapy with long-acting β-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) is the cornerstone treatment for patients with stable chronic obstructive pulmonary disease (COPD).
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