A CAT score ≥10 on a 0 to 40 scale indicates a high symptom burden from COPD and identifies patients who may benefit from daily maintenance treatment with long-acting bronchodilators. The COPD Assessment Tool (CAT) is a more comprehensive questionnaire that evaluates functional status in addition to degree of dyspnea in patients with COPD. The Modified Medical Research Council (mMRC) dyspnea scale rates the severity of dyspnea from 0 to 4, where a score of ≥2 indicates a high symptom burden of dyspnea. Dyspnea is the key symptom in this evaluation, and can be assessed by performing a careful history or using a validated scale. The GOLD report recommends that initial pharmacological treatment should be determined on an individual basis by evaluating the patient’s exacerbation history and current COPD symptoms. The report also highlights several key strategies central to achieving these treatment goals, including a reduction in exposure to risk factors such as smoking and air pollutants, administration of pneumococcal and influenza vaccinations, appropriate exercise, and pharmacological therapy. The 2020 GOLD report defines the goals of COPD treatment as reducing both current symptoms and the risk of future exacerbations. GOLD produces an annual evidence-based strategy document for COPD diagnosis and treatment. The Global Initiative for Obstructive Lung Disease (GOLD) was formed in the late 1990s through the combined efforts of the National Heart, Lung, and Blood Institute and the World Health Organization. An observational study in the USA found that there were 10.3 million physician office visits, 1.5 million emergency department visits, and 699,000 hospital discharges for COPD in 2010.

COPD is responsible for over 140,000 deaths and over $50 billion in combined direct and indirect costs annually in the USA.

In the USA, 12 million adults have been diagnosed with COPD, and similar numbers are thought to have the disease but remain undiagnosed. Large epidemiological studies demonstrate that over 380 million patients worldwide are affected by COPD, which is the fourth leading cause of death globally. This evidence supports the use of LAMA/LABA combinations as an initial maintenance therapy option for symptomatic patients with low exacerbation risk and severe breathlessness or patients with severe symptoms who are at risk of exacerbations, and as follow-up treatment in patients with uncontrolled symptoms or exacerbations on bronchodilator monotherapy.Ĭhronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. There is a lower risk of pneumonia with LAMA/LABA compared with ICS/LABA. The incidence of adverse events is similar with LAMA/LABA and LAMA alone. There are fewer studies comparing the impact of different medication classes on patients’ risk of exacerbations however, the available evidence suggests that LAMA/LABA treatment and LAMA monotherapy lead to a similar reduction in exacerbation risk, while the effect of LAMA/LABA compared with ICS/LABA remains unclear. Most studies show that LAMA/LABA treatment leads to greater improvements in lung function and symptoms than LAMA monotherapy or ICS/LABA treatment.

This review summarizes the position of LAMA/LABA combinations in treatment recommendations, and the evidence supporting their placement relative to LAMA monotherapy and ICS/LABA combination therapy, as well as differences within the LAMA/LABA class. Combinations of long-acting bronchodilator agents (LAMA/LABA) and inhaled corticosteroids combined with LABA (ICS/LABA) are also used as initial or follow-up therapy in patients with more severe symptoms or at risk of COPD exacerbations.

These medications include long-acting muscarinic antagonists (LAMA) and long-acting β 2-agonists (LABA). Long-acting inhaled bronchodilator medications are recommended as initial maintenance therapy for many patients with COPD.

Lama medication