Dual LABA/LAMA bronchodilators in COPD: why? when? and how?
Still many questions in our real everyday practice!
Read Editorial in Expert Review of Respiratory Medicine by great Italian team conducted by professor Mario Cazzola. 
LABA/LAMA combinations induce bronchorelaxant synergistic interaction when the drugs mixture is well-balanced and administered at low isoeffective concentrations.
The overall approach of Drug Companies has been to combine in a FDC a LABA and a LAMA at the same doses for which the monocomponents were previously approved. Indeed, this practice does not permit to optimize the synergy in the final
LABA/LAMA FDCs. Conversely, dose-finding studies are required to identify the correct dose-ratio and establish the minimal doses for each monocomponent in the FDC leading to the greater synergism with regard to the improvement in lung
function, symptoms, and exacerbations.
Furthermore, although LABA/LAMA FDCs are characterized by an acceptable safety profile, the cardiovascular toxicity of LABAs and LAMAs may overlap. Thus, postmarketing surveillance and observational studies are needed to assess the real risk of rare, but potentially serious, cardiovascular adverse events associated with the dual bronchodilation therapy in COPD patients.
Full text: