Dual use of bronchodilators versus monotherapy, and its impact on pulmonary rehabilitation in COPD patients

Pulm Pharmacol Ther. 2020 Apr;61:101898. doi: 10.1016/j.pupt.2020.101898. Epub 2020 Jan 21.


Introduction: Long-acting bronchodilators are the therapy with the best evidence for treating stable chronic obstructive pulmonary disease (COPD). Long-acting combinations of β2 agonists and anticholinergics (LABA-LAMA) are recommended in advanced stages when monotherapy has not generated the desired effects. Pulmonary Rehabilitation (PR) is an effective non-pharmacological strategy. The aim of this study was to compare the results obtained in patients with COPD who received monotherapy versus dual bronchodilator therapy in terms of functional aerobic capacity, symptoms and quality of life.

Materials and methods: Prospective non randomized intervention study; the patients were divided into two groups: in one group patients were treated with LAMA (Tiotropium Bromide, 5 μg every 24 h) and in the other group patients were treated with LABA + LAMA (Indacaterol/Glycopyrronium, 110/50 μg once a day). After receiving the concept of pulmonology, patients were intervened with 8 weeks of PR. The study was approved by the committee of the Clinica Neumológica del Pacifico in Cali and the Institución Universitaria Escuela Nacional del Deporte, Colombia. To determine the differences, t pair test for intragroup, and t-test was performed for intergroup analysis. For all tests, a p-value <0.05 was considered as statistically significant.

Results: 53 patients participated in this study, of which 20 were assigned to the LAMA group and 33 to the LAMA + LABA group. Patients in both groups presented changes in the distance of the 6MWT, in the VO2e, dyspnea and in all the SGRQ domains. Regarding the comparison between groups, there were found no differences in the variables at the beginning of the PR and significant differences (p < 0.05) at the end of the 8 week-period in favor of the LABA + LAMA group, in symptoms with the mMRC scale, functional aerobic capacity with the 6 min walking test and in health related quality of life specifically in the symptoms domain, where the dual therapy group obtained better results.

Conclusion: The addition of LABA to the treatment with LAMA showed better response results compared with the monotherapy in patients with COPD who attended PR.

MeSH terms

  • Adrenergic beta-2 Receptor Agonists / administration & dosage
  • Adrenergic beta-2 Receptor Agonists / therapeutic use*
  • Aged
  • Aged, 80 and over
  • Bronchodilator Agents / administration & dosage*
  • Drug Therapy, Combination
  • Female
  • Glycopyrrolate / therapeutic use
  • Humans
  • Indans / therapeutic use
  • Male
  • Middle Aged
  • Muscarinic Antagonists / administration & dosage
  • Muscarinic Antagonists / therapeutic use*
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Quinolones / therapeutic use
  • Tiotropium Bromide / therapeutic use


  • Adrenergic beta-2 Receptor Agonists
  • Bronchodilator Agents
  • Indans
  • Muscarinic Antagonists
  • Quinolones
  • indacaterol
  • Glycopyrrolate
  • Tiotropium Bromide