Long-acting Bronchodilators in COPD Management: One or Two?

The management of chronic obstructive pulmonary disease (COPD) has changed significantly in this century, the most important element being the introduction of long-acting bronchodilators (LABD) as the basis of the treatment of patients with symptomatic disease. The benefits of dual bronchodilators versus mono-bronchodilators have been shown in randomized trials and in real-life observational studies and include, besides the expected improvement in lung function, improvement in symptoms, quality of life and exercise capacity, better exacerbation prevention and potential cardiovascular benefits in patients with hyperinflation, with an acceptable safety profile. Dual bronchodilators can be the first-line agents in all symptomatic patients, as well as in exacerbating patients (especially if they have lower blood eosinophils and their exacerbations were treated with antibiotics). The place for mono-LABD (mainly long-acting muscarinic antagonists [LAMA]) remains for the less symptomatic patients without severe hyperinflation. Modern COPD management incorporates the individualized approach of each COPD patient with the appropriate treatment