The meta-analytic signal indicates that an equal number of patients would die or have cardiac SAEs on LABA+LAMA or LABA+ICS, and in an observational, real-life study the LABA+LAMA combination had similar or lower risk of these events in comparison to LABA+ICS. A statistically significant reduction in the risk for pneumonia with LABA+LAMA compared with LABA+ICS has been repeatedly documented by various meta-analyses. Whether SAMA is needed is unknown in patients on ICS/LABA/LAMA. LABA/LAMA combination therapy results in fewer exacerbations than monotherapy, with a number needed to treat (NNT) of 12 to prevent one exacerbation (95 CI, 8 to 29). However, this evidence in real life is less solid because of the lack of appropriate studies. Conclusion: Overmedication of LAMA and SAMA nebs at exacerbation is common. This review summarizes the evidence for the use of LAMA/LABA combination inhalers, which is reflected in current treatment recommendations, to assist primary care practitioners in selecting the most appropriate therapy for patients with COPD. LABA+LAMA caused significantly less AEs and SAEs. LAMA/LABA combination inhalers available in the USA (Table 1). Several meta-analyses have compared the pooled safety data from randomized clinical trials (RCTs) of LABA+LAMA combinations with LABA+ICS combinations. However, both combination types can induce adverse events (AEs).Ĭurrent literature on LABA+LAMA and LABA+ICS combinations has been reviewed with a specific focus on their safety profile in the treatment of COPD. In this article, we review global and national guideline recommendations for the use of LABA/LAMA combination therapy in COPD and synthesize the key evidence for the benefits of LABA/LAMA versus (1) monotherapy, (2) LABA/ICS and (3) LABA/LAMA/ICS, drawing on data from systematic reviews, meta-analyses, and individual studies of LABA/LAMA. LABA+LAMA and LABA+ICS combinations are key pharmacological approaches to the treatment of COPD. Combination inhalers containing both a LABA and an ICS are recommended to improve adherence, and ensure that the LABA is not taken alone without the ICS.
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