Comparing Dual Bronchodilators for COPD

Guidelines recommend that patients with symptomatic chronic obstructive pulmonary disease (COPD) be started on a dual inhaler containing a long-acting muscarinic antagonist (LAMA) and a long-acting β₂-agonist (LABA). But which inhaler is best? (Figure 1)

To address this question, investigators analyzed claims data from thousands of patients with COPD who initiated one of three LAMA–LABA inhalers:

• Umeclidinium–vilanterol, a once-daily dry-powder inhaler (Anoro Ellipta)

• Tiotropium–olodaterol, a once-daily soft-mist inhaler (Stiolto Respimat)

• Glycopyrrolate–formoterol, a twice-daily metered-dose inhaler (Bevespi Aerosphere)

Outcomes for these three options were compared in pairs in propensity-matched analyses adjusted for baseline difference…