Dual Bronchodilator Therapy: A Review

Inhaled bronchodilators with or without inhaled steroids (IGCs) are the mainstay of pharmacological
treatment for stable obstructive airway diseases, including beta2-agonists and muscarinic antagonists.
Long-acting muscarinic antagonist bronchodilators (LAMA) and long-acting β2-agonists (LABA) are
the treatment of choice for moderate to severe chronic obstructive pulmonary disease (COPD). Also
some studies have demonstrated the benefit of LAMA in the treatment of difficult-to-control asthma
and the potential use in asthma-COPD overlap (ACO). Control of airway tone in health and disease
states, cholinergic and adrenergic receptors, signaling, molecular biology of mediators, and airway
muscle contraction / relaxation mechanisms are reviewed concisely and as they may be handled
pharmacologically. Subsequently, the evidence of the role of the LABA / LAMA combination in the
aforementioned entities, their complementary mechanisms of action and other alternative
mechanisms of action as well as potential deleterious effects is discussed.