Effects of LAMA/LABA Alone and in Combination on Cardiac Safety

Chronic obstructive pulmonary disease (COPD) is a multidimensional, progressive condition characterized by airflow obstruction, worsening dyspnea and respiratory failure. xtensive clinical data show that the LAMA tiotropium (SPIRIVA ; Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany) delivered as a dry powder formulation by HandiHaler (DPI; 18 g nominal dose) or as an aqueous solution via the Respimat Soft Mist inhaler (SMI; 5 g nominal dose) can improve lung function, symptoms and outcomes, such as dyspnea and quality of life, and reduce exacerbations in patients with COPD. 2 Olodaterol (Striverdi ; Boehringer Ingelheim Pharma GmbH & Co K.G., Ingelheim, Germany) is a LABA that provides 24-hr bronchodilation, and has been shown to improve lung function and reduce symptoms in patients with COPD. atients with COPD often have comorbidities that can impact disease management, including choice of treatment. The most serious and prevalent comorbidities are cardiovascular (CV) diseases, In a study by Fuhrman et al in patients for whom COPD was an associated cause of death, 32.0% of patients had an underlying CV disease, and 13.6% of the total population had ischemic heart disease. As such, initial concerns were raised regarding the cardiac safety of LAMAs and LABAs, particularly among patients with CV comorbidities. 10,11 For LABAs, for example, there are theoretical concerns over increases in heart rate and blood pressure resulting from their interaction with 2 -adrenoceptors in the atria, ventricles and peripheral vasculature via the baroreflex mechanism. 12 4] These data show that tiotropium and olodaterol given as monotherapy have similar, or lower, AE rates than placebo,