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Practical considerations when prescribing a long-acting muscarinic antagonist for patients with COPD

Authors D’Urzo AD, Kardos P, Wiseman R

Received 2 January 2018

Accepted for publication 16 February 2018

Published 4 April 2018 Volume 2018:13 Pages 1089—1104


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Anthony D D’Urzo,1 Peter Kardos,2 Russell Wiseman3

1Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, ON, Canada; 2Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, Frankfurt, Germany; 3Suncoast Medical Centre, Coolum Beach, QLD, Australia

Abstract: COPD is characterized by persistent airflow limitation, progressive breathlessness, cough, and sputum production. Long-acting muscarinic antagonists (LAMAs) are one of the recommended first-choice therapeutic options for patients with COPD, and several new agents have been developed in recent years. A literature search identified 14 published randomized, placebo-controlled studies of the efficacy and safety of LAMAs in patients with COPD, with improvements seen in lung function, exacerbations, breathlessness, and health status. A greater weight of evidence currently exists for glycopyrronium (GLY) and tiotropium than for umeclidinium and aclidinium, especially in terms of exacerbation reductions. To date, there have been few head-to-head clinical studies of the different LAMAs. Available data indicate that GLY and aclidinium have similar efficacy to tiotropium in terms of improving lung function, dyspnea, exacerbations, and health status. Overall, evidence demonstrates that currently available LAMAs provide effective and generally well-tolerated therapy for patients with COPD. Delivery devices for the different LAMAs vary, which may affect individual patient’s adherence to and preference for treatment. Subtle differences between individual therapeutic options may be important to individual patients and the final treatment choice should involve physician’s and patient’s experiences and preferences.

Keywords: COPD, long-acting muscarinic antagonist, efficacy, safety, inhaler, adherence

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