There are now four dual bronchodilators available on the market for the treatment of chronic obstructive pulmonary disease (COPD). Each inhaler includes a long acting Beta2 agonist (LABA) and a long acting muscarinic antagonist (LAMA). In this article we consider when they might be used, why they might help practice nurses to manage COPD, and how to select the right options.
The NICE guidelines for COPD were published in 2010 and have not been updated since then1. In contrast the Global Initiative for Obstructive Lung Disease (GOLD) guidelines are updated each year and include some of the current thinking regarding managing this condition, which has a severe burden of morbidity and mortality2. For some time it has been recognised that people with COPD can present in different ways and that it’s not a homogenous disease. For example, some patients suffer from breathlessness but tend not to have problems with exacerbations; while others will suffer from recurrent exacerbations a couple of times a year or more.