Combination Bronchodilators – An Analysis of Benefits

Combination Bronchodilators Improve Lung Function, Quality of Life, and Shortness of Breath

Background: There are two different types of bronchodilators (inhaled medications) that relax the muscle that wraps around the breathing tubes to allow more air to go in and out of the lungs. One type is called a beta2-agonist, and the other type is called a muscarinic antagonist.

Respiratory system - shows where combination bronchodilators work to open airways

Most of the 23 branches (divisions) of breathing tubes have muscle that wraps around the outside.

Why is This Is Important for You to Know? Because these two types of bronchodilators work in different ways to open breathing tubes. In the US, there are currently 4 available combinations of these two types of bronchodilators in a single inhaler device. In alphabetical order, the brand names are: Anoro; Bevespi; Stiolto; and Utibron.

Study: Because these combination bronchodilators are relatively new, Dr. Oba and colleagues at the University of Missouri School of Medicine reviewed 23 different studies that compared combination bronchodilators with one bronchodilators (called monotherapy). The analysis was published in the journal Thorax; year 2016; volume 71; pages 15-25.

Results: A total of 27,172 patients with COPD were included in the analysis. The combination bronchodilators had significantly greater improvements in breathing tests, quality of life score, and shortness of breath with daily activities compared with just one bronchodilator. In addition, there were fewer moderate-to-severe flare-ups (called exacerbations) with combination therapies compared with long-acting beta2 bronchodilators, but not compared with long-acting muscarinic antagonists.

Finally, there were no differences in safety with combination bronchodilators compared with a single medication.

Conclusions: Combination therapy was most effective in improving breathing tests, ability to breathe easier with daily activities, and overall quality of life. Safety was similar between combinations and monotherapy.

Like lollipops, combnation bronchodilators are better than one

Child holding two lollipops

My Comments: These findings support the simple observation that 2 is better than 1 with most things in life, including bronchodilators. Certainly, most children would rather have two lollipops than just one. The same concept applies to combination bronchodilators for those with COPD. Make sure to ask your health care professional whether you would benefit from combination therapy.