Is there a rationale for combining long-acting antimuscarinic agents and β2-agonists?

Asthma and chronic obstructive pulmonary disease (COPD) are both airway diseases affected by genetics; they are not yet well known, and they have environmental interactions. Chronic inflammation underlies both diseases. Both conditions involve small airways, causing a slightly large decrease in airway function; both cause airway obstruction and constriction of smooth muscle. International guidelines recommend the use of bronchodilators and suggest that these drugs are still the usual first-line approach in the current management of COPD. Longacting bronchodilators, such as long-acting β2-adrenoceptor agonists (LABAs) and long-acting antimuscarinic anticholinergics (LAMAs), demonstrate an advance on short-acting bronchodilators. In asthma and COPD, the chronic treatment with these agents improves lung function, decreases nocturnal asthma, and decreases the need for short-acting inhaled β2-adrenoceptor agonists. The current opinion is that it will be advantageous to develop inhalers containing combinations of several classes of LAMAs and LABAs. © FBCommunication - Modena (Italy).