{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T01:03:14Z","timestamp":1791421394021,"version":"4.3.3"},"reference-count":57,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim Pharmaceuticals Inc.","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Respir Dis"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>\n                    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Faster lung function impairment occurs earlier in the disease, particularly in mild-to-moderate COPD, highlighting the need for early and effective targeted interventions. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024 report recommends initial pharmacologic treatment with a long-acting muscarinic antagonist (LAMA) and long-acting \u03b2\n                    <jats:sub>2<\/jats:sub>\n                    -agonist (LABA) combination in group B (0 or 1 moderate exacerbation not leading to hospitalization, modified Medical Research Council score of \u2a7e2, and COPD Assessment Test\u2122 score of \u2a7e10) and E (\u2a7e2 moderate exacerbations or \u2a7e1\u2009exacerbation leading to hospitalization and blood eosinophil count &lt;300\u2009cells\/\u00b5L) patients. In randomized controlled trials (RCTs), LAMA\/LABA combination therapy improved lung function, St. George\u2019s Respiratory Questionnaire (SGRQ) total score, and Transitional Dyspnea Index (TDI) focal score and reduced the use of rescue medications, exacerbation risk, and risk of first clinically important deterioration (CID), compared with LAMA or LABA monotherapy. However, there is limited evidence regarding the efficacy and safety of LAMA\/LABA combination therapy versus LAMA or LABA monotherapy in maintenance therapy\u2013na\u00efve patients. This review discusses the rationale for the early initiation of LAMA\/LABA combination therapy in maintenance therapy\u2013na\u00efve patients with COPD. In post hoc analyses of pooled data from RCTs, compared with LAMA or LABA monotherapy, LAMA\/LABA combination therapy improved lung function and quality of life and reduced COPD symptoms, risk of first moderate\/severe exacerbation, risk of first CID, and use of rescue medication, with no new safety signals. In a real-world study, patients initiating LAMA\/LABA had significantly reduced risk of COPD-related inpatient admissions and rate of on-treatment COPD-related inpatient admissions over 12\u2009months than those initiating LAMA. Consequently, LAMA\/LABA combination therapy could be considered the treatment of choice in maintenance therapy\u2013na\u00efve patients with COPD, as recommended by the GOLD 2024 report.\n                  <\/jats:p>","DOI":"10.1177\/17534666241279115","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T11:33:08Z","timestamp":1727782388000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Long-acting muscarinic antagonist and long-acting \u03b2\n                    <sub>2<\/sub>\n                    -agonist combination for the treatment of maintenance therapy\u2013na\u00efve patients with chronic obstructive pulmonary disease: a narrative review"],"prefix":"10.1177","volume":"18","author":[{"given":"Roland","family":"Buhl","sequence":"first","affiliation":[{"name":"Pulmonary Department, Johannes Gutenberg University Hospital, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9850-9520","authenticated-orcid":false,"given":"Marc","family":"Miravitlles","sequence":"additional","affiliation":[{"name":"Pneumology Department, Hospital Universitari Vall d\u2019Hebron\/Vall d\u2019Hebron Institut de Recerca (VHIR), Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7007-588X","authenticated-orcid":false,"given":"Antonio","family":"Anzueto","sequence":"additional","affiliation":[{"name":"The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3901, USA"},{"name":"South Texas Veterans Health Care System, San Antonio, TX 78229-3901, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Brunton","sequence":"additional","affiliation":[{"name":"Primary Care Respiratory Group, Winnsboro, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,10,1]]},"reference":[{"key":"bibr1-17534666241279115","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(23)00217-6"},{"key":"bibr2-17534666241279115","unstructured":"Global initiative for chronic obstructive lung disease. 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