Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Urgent Care


Dr. Nancy Reid



Chronic obstructive pulmonary disease (COPD) is a prevalent disease worldwide affecting millions of people. There are a number of inhaled bronchodilators and corticosteroids for COPD maintenance therapy to reduce exacerbation frequency and severity. The question that needs to be answered in this clinical review is the following: Are there any inhaled maintenance medications individually, as a class, or in combination that are more efficacious at reducing the severity of a COPD exacerbation as well as the frequency and length of time that a COPD exacerbation occurs? The classes of inhaled medications in this clinical review include long acting beta 2 agonists (LABA), long acting muscarinic antagonists (LAMA), and inhaled corticosteroids (ICS).


Randomized-controlled trials were reviewed to determine the effectiveness of LABA, ICS, and LAMA classes to determine which class or classes may be more efficacious in reducing COPD exacerbations.


The LAMA medications as a class compared to the LABA class showed an increased time to first COPD exacerbation and also resulted in less exacerbations annually. The LAMA-LABA combinations of medications also showed an increased time to first exacerbation as well as less annual COPD exacerbations compared to the LABA-ICS classes of medications. Neither the LAMA, LABA, or ICS classes of medications showed an increase in any adverse outcomes.


It is concluded that the use of LAMA medications either alone or in combination with an LABA or LABA plus ICS can decrease the number of COPD exacerbations occurring annually and may reduce the severity of the exacerbation.


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