Breathe Easier with Two Bronchodilators: Less Shortness of Breath and Less Albuterol Use

Breathe Easier with Two Bronchodilators

Background: About 90% of patients with COPD are still short of breath with activities if using a single long-acting bronchodilator (either a beta-agonist or a muscarinic antagonist). In such situations, the 2017 GOLD statement recommends use of a combination of both classes of bronchodilators to achieve the best effects (see my post under the heading COPD News on December 3, 2016). Thus, the experts on the GOLD committee agree that you should be able to breathe easier with two bronchodilators. 

Study: Dr. Edward Kerwin and co-authors who work at GlaxoSmithKline pharmaceutical company studied a total of 494 patients with COPD who reported that they experienced at least some shortness of breath despite taking a long-acting bronchodilator tiotropium (brand name: Spiriva) in the HandiHaler device for at least three months. Patients were assigned by chance to either continue Spiriva HandiHaler OR to use a combination of

Anoro Ellipta enables patients to breathe easier with two bronchodilators

Anoro Ellipta contains two different bronchodilaors

two bronchodilators (brand name: Anoro Ellipta). The study results were published in the International Journal of COPD, 2017, volume 12, pages 745-755.

Results: Compared with a single bronchodilator (brand name, Spiriva HandiHaler), there were significantly greater improvements in breathing tests (lung function), the need to use albuterol as a rescue inhaler, and in shortness of breathe with activities of daily living. There were no differences is side effects between treatments.

Conclusions: Two different classes of bronchodilators provide greater benefits, including being able to breathe easier, than one bronchodilator.

My Comments: The results of this study are consistent with several other trials showing quite simply that “two is better than one” in most things in life including inhaled bronchodilators.

Bevespi contains two different bronchodilators in a single device

Bevespi Aerosphere contains two different bronchodilators

At the present time there are three available “two in one” bronchodilator inhalers – brand names are Anoro, Stiolto, and Bevespi. A fourth one called Utibron should become available in the near future.

Stiolto Respimat contains two different bronchodilators

If you are taking a single inhaled bronchodilator and have shortness of breath, I suggest that you ask your health care professional whether a trial of a “combination bronchodilator” is reasonable. At least one of these options should be covered by most health insurance policies.


Incruse Ellipta is Now Available

On April 30, 2014, the United States Food and Drug Administration approved umeclidinium (brand name: Incruse Ellipta) as a once-daily inhaled bronchodilator for treatment of those with COPD, including chronic bronchitis and emphysema. As of January 2015, this medication is available in US pharmacies.

Incruse Ellipta is a once-daily dry powder bronchodilator

Incruse Ellipta is a once-daily dry powder bronchodilator

Incruse Ellipta is in the class of bronchodilators called long-acting muscarinic antagonists (LAMA).  Other approved medications in this class are tiotropium (brand name: Spiriva HandiHaler and Respimat) and aclidinium (brand name: Tudorza Pressair). These medications open the airways and make it easier to breathe by blocking a receptor in the muscles that wrap around breathing tubes.

Picture of Spiriva Respimat mist bronchodilator

Spiriva Respimat is a once daily bronchodilator that delivers a mist


Tudorza Pressair is a twice daily dry powder bronchodilator

Tudorza Pressair is a twice daily dry powder bronchodilator


Information about the bronchodilator (called the package insert) states that Incruse Ellipta should be used with caution in those with narrow-angle glaucoma and with urinary retention due to enlargement of the prostate. The most common reported side effect in studies was nasopharyngitis (irritation of nose and throat). Also, you should not take this medication if you are using Spiriva or Tudorza as they are the same type of brocnhodilators.

As always, you should discuss any new medication with your doctor.

Umeclidinium (Incruse Ellipta) approved for COPD

GOOD NEWS! Umeclidinium approved to treat COPD.

On April 30, 2014, The United States Food and Drug Administration (FDA) approved a new bronchodilator called umeclidinium (brand name is Incruse™ Ellipta™). This dry powder medication is approved for once-daily maintenance treatment for patients with COPD including both chronic bronchitis and emphysema.  The approved dose is 62.5 mcg.  The approval was based on study results in over 2,500 patients with COPD and follows approval of this medication in Canada and Europe.

This medication belongs to the class of bronchodilators called a long-acting muscarinic antagonist (LAMA) and is similar to the once daily tiotropium (brand name: Spiriva™ HandiHaler™) and twice daily aclidinium (brand name: Tudorza™ Pressair™). As these three LAMA medications are the same class, you should only use of these bronchodilators at a time.

GlaxoSmithKline, the pharmaceutical company that makes Incruse™ Ellipta™, reported that the most common side effects are nasopharyngitis, upper respiratory tract infection, cough, and joint pain. The company warned that the medication should not be used if you have narrow-angle glaucoma or have problems with urination. GlaxoSmithKline plans to launch the medication in the US toward the end of 2014.