New dual-acting bronchodilator treatments for COPD, muscarinic antagonists and β2 agonists in combination or combined into a single molecule

Expert Opin Investig Drugs. 2013 Dec;22(12):1569-80. doi: 10.1517/13543784.2013.833182. Epub 2013 Aug 21.


Introduction: It has long been known that combining short-acting muscarinic antagonists and β2 agonists produces additive effects on the lung function of patients with chronic obstructive pulmonary disease (COPD). Two closely related approaches to provide long-acting treatments offering the same functional are compared.

Areas covered: Six combinations of long-acting muscarinic antagonists and β2 agonists are in clinical development, with five having progressed to Phase III studies or regulatory filing. Two dual-acting muscarinic antagonist/β2 agonist molecules have progressed to Phase II clinical studies, with two more having been identified as in clinical development.

Expert opinion: Both approaches have been shown to provide clinically enhanced bronchodilator activity that is superior to that offered by the current standard treatments, but clinical results have yet to clearly demonstrate that these new combinations also provided an enhanced reduction in the frequency of disease exacerbations. At least one of these combinations should reach the market in 2014, so by the end of 2015, it should be clear how useful such combinations may be in the treatment of COPD.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-2 Receptor Agonists / administration & dosage*
  • Bronchodilator Agents / administration & dosage*
  • Drug Combinations
  • Drug Therapy, Combination
  • Humans
  • Muscarinic Antagonists / administration & dosage*
  • Pulmonary Disease, Chronic Obstructive / drug therapy*


  • Adrenergic beta-2 Receptor Agonists
  • Bronchodilator Agents
  • Drug Combinations
  • Muscarinic Antagonists