Benefits of Two Bronchodilators in One Inhaler
Background: COPD treatment guidelines recommend the combined use of the two different classes of inhaled long-acting bronchodilators if your symptoms (usually shortness of breath) are not improved by one medication. One class is called beta-agonist, while the other is called muscarinic antagonist. These medications work in different ways to dilate, or open, your airways, making it easier to breathe.
Study: In the August 2014 issue of CHEST, Rodrigo and Plaza reviewed the benefits and safety of the combination of two bronchodilators in one inhaler. These medications are indacaterol (a beta-agonist) and glycopyrronium (a muscarinic antagonist). This combination is called QVA149, and the brand name is Ultibro Breezhaler.
The authors examined five different studies that involved 4,842 patients with COPD. QVA149 consistently improved results of breathing tests compared with tiotropium (Spiriva), a long-acting muscarinic antagonist. Two studies considered the effects of QVA149 on relieving breathlessness with daily activities and improving health status (quality of life) compared with tiotropium. QVA149 provided greater improvements in these important patient-reported outcomes than tiotropium.
Further analysis showed there were no differences in side effects as reported by patients between QVA149 and tiotropium.
These findings support the overall experience of doctors and patients with COPD that two bronchodilators are usually better than one. It is certainly convenient for those with COPD to inhale two long-acting bronchodilators from a single inhaler in the morning. The benefits last 24 hours.
Ultibro Breezhaler is currently approved for use in over 30 countries, including the European Union, Japan, Canada, Mexico, and Australia. Novartis, the pharmaceutical company that makes QVA149, plans to submit materials to the US Food and Drug Administration (FDA) in the near future to obtain regulatory approval.
Although QVA149 is not currently available in the US, a similar medication
Utibro Neohaler contains two different bronchodilators
called Anoro Ellipta was approved in 2013 by the FDA as maintenance treatment for those with COPD. Anoro Ellipta contains vilanterol, a beta-agonist, and umeclidinium, a muscarinic antagonist, in a single inhaler. You inhale the dry powder in the morning.
It is important to understand that you should NOT take other long-acting beta-agonists (such as arformoterol, formoterol, indacaterol, or salmeterol) or long-acting muscarinic antagonists (such as aclidinium or tiotropium) if you are using Anoro. Also, the FDA requires that pharmaceutical companies provide a box warning that long-acting beta-agonists, such as vilanterol in Anoro, increase the risk of asthma-related deaths. However, Anoro is approved to treat COPD and not asthma. You should not take this medication if you have asthma.
You may wish to ask your doctor about this once daily dual bronchodilator medication.
Donald A. Mahler, MD
Anoro Ellipta dry powder inhaler