Combined Long-Acting Bronchodilator Therapy Compared With Monotherapy for COPD

Eighteen RCTs with a total of 6086 patients were included in the analysis.

For patients with moderate to severe chronic obstructive pulmonary disease (COPD), dual bronchodilator therapy with a long-acting β-agonist (LABA) plus a long-acting muscarinic antagonist (LAMA) was found to improve lung function without increasing adverse events when compared with LAMA monotherapy, according to the findings of a recently published meta-analysis. 

To investigate whether the benefits of dual bronchodilator therapy outweigh the potential risk for increased adverse events, study authors searched PubMed, CINAHL, and Web of Science databases from inception to March 2020 for randomized controlled trials (RCTs) that compared treatment with LABA + LAMA vs LAMA in adults with moderate to severe COPD. 

Eighteen RCTs with a total of 6086 patients were included in the analysis. Data collected from each study included trough FEV1 [forced expiratory volume at 1s] and SGRQ (St George Respiratory Questionnaire) scores (at baseline and 12 weeks) for efficacy analysis and the incidence of adverse events, serious adverse events, and cardiovascular events (at 12 weeks) for safety analysis.

Findings of the study revealed that treatment with dual bronchodilator therapy yielded a greater improvement in FEV1 from baseline to 12 weeks compared with LAMA monotherapy (mean difference [MD], 0.08; 95% CI, 0.05-0.11). Results also showed no difference in SGRQ scores between the groups (odds ratio [OR] −0.85; 95% CI, −1.83-0.13). 

Additionally, safety analysis revealed no differences in overall adverse events (OR 1.00; 95% CI, 0.92-1.09) between the groups; serious adverse events (OR 1.01; 95% CI, 0.86-1.18) and cardiovascular events (OR 0.88; 95% CI, 0.58-1.34) were also found to be similar. 

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“Although combination therapy did not significantly improve symptom scores compared with monotherapy, any further improvement in FEV1 resulting from combined LABA + LAMA may benefit patients with COPD in the long term,” the authors concluded.


Lipari M, Pramodini KPB, Wilhelm SM. Dual-versus mono-bronchodilator therapy in moderate to severe COPD [published online June 4, 2020]. Annals of Pharmacotherapy. doi: 10.1177/1060028020932134.