Indacaterol/Glycopyrronium Combination for COPD

In all current guidelines and recommendations of the management of COPD, inhaled bronchodilators are the pillar of therapy at each stage of the disease. Dual bronchodilation with long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) is always more effective than the LAMA or LABA alone in terms of the improvement in trough FEV1, and transitional dyspnea index and St. George’s Respiratory Questionnaire scores. Indacaterol/glycopyrronium has been the first LABA/LAMA to be developed and approved as a maintenance bronchodilator treatment to relieve symptoms in adult patients with COPD. It has received approval from numerous regulatory authorities around the world because of the results of the pivotal Phase III programs IGNITE, which explored indacaterol/glycopyrronium 110/50 μg once-daily across 52 countries, and EXPEDITION, which explored indacaterol/glycopyrronium 27.5/15.6 μg twice-daily in US. Although guidelines and recommendations suggest a “slow” gradual therapeutic strategy, we advocate the need to start immediately, until the time of diagnosis, the treatment of COPD patients with indacaterol/glycopyrronium in order to optimize bronchodilation, because we strongly believe the rapid improvement in symptoms that it is able to elicit could help patients’ adherence to treatment, which may be otherwise discouraged by a “slow” gradual therapeutic approach.