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Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care

Miriam Barrecheguren, Mónica Monteagudo and Marc Miravitlles.
npj Prim Care Respir Med 2018;28:36.
doi: 10.1038/s41533-018-0102-x

Long-acting bronchodilators, including long-acting muscarinic antagonists (LAMAs) and long-acting beta2-agonists (LABAs), are a popular treatment option for patients with chronic obstructive pulmonary disease (COPD). Studies have shown that dual therapy (i.e. LAMA/LABA combinations) has greater efficacy than monotherapy in improving patient symptoms and health status. Although this data is compelling, these studies often exclude patients with mild dyspnoea, only comparing the use of mono and dual therapy in patients with moderate to severe dyspnoea. This study, based in Catalonia, Spain, aimed to use the SIDIAP database to describe the characteristics and outcomes of COPD patients starting either LAMA monotherapy or LAMA/LABA dual therapy. Researchers identified 5,729 patients with a diagnosis of COPD who started treatment with either a LAMA (69.8% of the sample) or LAMA/LABA (30.2%). Results demonstrated that patients initially treated with dual bronchodilators had a lower forced expiratory volume in 1 second (FEV1) and a greater number of previous hospital admissions than those initially started on monotherapy. This suggests a difference in disease severity between mono and dual therapy. No other differences in clinical characteristics between LAMA or LAMA/LABA users were found. Patients treated with LAMA or LAMA/LABA therapies showed a decrease in the number of exacerbations from the previous year. Based on these findings, researchers concluded that initial monotherapy may be an adequate treatment option for patients diagnosed with mild to moderate COPD and a low risk of exacerbations, reserving dual therapy for use in patients with severe COPD.

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