April 2026
Umeclidinium-vilanterol dry powder inhalers may be linked with improved clinical outcomes for COPD exacerbations
By Melanie Hinze
Use of once-daily dry powder inhalers (DPIs) is associated with lower risk of moderate or severe chronic obstructive pulmonary disease (COPD) exacerbations compared with once-daily soft mist inhalers (SMIs) or twice-daily metered-dose inhalers (MDIs), suggests new research published in JAMA Internal Medicine.
The US observational active-comparator study analysed insurance claims from patients aged at least 40 years who were newly treated with long-acting muscarinic antagonist and long-acting β2-agonist (LAMA-LABA) inhalers, and who were continuously enrolled in a large commercial government health insurance plan during the 183-day baseline period of the study.
The cohorts comprised 9479 matched pairs of patients receiving the DPI umeclidinium-vilanterol versus the MDI glycopyrrolate-formoterol, 9598 receiving the SMI tiotropium-olodaterol versus glycopyrrolate-formoterol and 36,740 receiving umeclidinium-vilanterol versus tiotropium-olodaterol.
The researchers found that umeclidinium-vilanterol was associated with a 14% lower hazard of a first moderate or severe COPD exacerbation than glycopyrrolate-formoterol, and a 3% lower hazard than tiotropium-olodaterol.
Tiotropium-olodaterol was associated with a 6% lower hazard of a first moderate or severe COPD exacerbation than glycopyrrolate-formoterol.
The researchers also found similar risks of first major cardiovascular event, urinary tract infection and pneumonia hospitalisation among patients in all three cohorts.
Adjunct Associate Professor Debbie Rigby from the School of Pharmacy and Pharmaceutical Sciences at the University of Queensland, and Clinical Executive Lead at the National Asthma Council Australia, Melbourne, said a critical goal of COPD management was reducing exacerbations, as these events were drivers of disease progression, mortality and healthcare utilisation.
‘Each exacerbation is associated with an accelerated decline in lung function, increased symptom burden and an increased risk of future exacerbations,’ she said. ‘From a clinical viewpoint, reducing exacerbations improves quality of life, and reduces hospital admissions and readmissions,’ she added.
Professor Rigby told Medicine Today that, in general, the best inhaler was the one that a patient could and would use. She said that patient preference in inhaler types was important as it influenced adherence to therapy. As such, inhaler device selection should be individualised, and could be based on assessment of the patient’s inspiratory flow, dexterity, co-ordination and preferences.
Professor Rigby added that once-daily dosing may better suit some patients from an adherence point of view, noting that this study showed a reduced risk of moderate or severe exacerbations for once-daily DPIs compared with twice-daily MDIs. Once-daily SMIs were also slightly favoured over twice-daily MDIs.
‘The results of this study show a potential benefit for prescribing once-daily umeclidinium-vilanterol via a DPI,’ she said.
‘The reduction in moderate to severe exacerbations compared with MDIs is significant, plus with the added benefit of lower greenhouse gas emissions and less environmental impact,’ she concluded.