Dual Bronchodilator Therapy in Obstructive Pulmonary Disease

Inhaled bronchodilators with or without inhaled steroids (IGCs) are the mainstay of pharmacological treatment for stable obstructive airway diseases, including beta 2-agonists and muscarinic antagonists. Long-acting muscarinic antagonist bronchodilators (LAMA) and long-acting 2-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 entities, their complementary mechanisms of action and other alternative mechanisms of action as well as potential deleterious effects is discussed.