Emerging inhaled long-acting beta-2 adrenoceptor agonists for the treatment of COPD

Introduction: Chronic obstructive pulmonary disease (COPD), characterized by persistent and partially reversible airflow obstruction, is a leading cause of morbidity and mortality worldwide. Long-acting inhaled bronchodilators form the backbone for the maintenance therapy for this disease. The ultra-long-acting beta(2)-agonists (ultra-LABAs) represent novel pharmacologic agents with interesting potential benefits as stand-alone therapy or in combination with other therapies for the treatment of COPD. Areas covered: In this review, we will focus newly developed ultra-LABAs, describing currently available evidence of their clinical effect and safety, their comparison relative to older long-acting beta(2)-agonists, and their potential niche in the maintenance treatment of COPD. We also provide an overview of the current landscape of available LABAs, and discuss the present understanding of the disease, and suggest possible future directions for COPD therapy. Expert opinion: Ultra-LABAs are pivotal bronchodilators in the maintenance therapy of COPD as monotherapy or in combination with other agents. Their long-acting effect permits once daily dosing and their improved delivery using novel devices and their safety profile represent an important advancement in management of this disease.