Bronchodilators

• (1st-line): long-acting muscarinic antag (LAMA), β2-agonists (LABA)

LAMA (eg, tiotropium):

↓ exacerb, slows ↓ FEV1, ↓ admit, ↓ resp failure; better than ipratropium or LABA (NEJM 2008;359:1543; 2011;364:1093; 2017;377:923)

LABA:

~11% ↓ in exacerbations, no ↑ in CV events (Lancet 2016;387:1817)

LAMA + LABA:

↑ FEV1, ↓ sx vs. either alone (Chest 2014;145:981) and superior to LABA + inh steroid (NEJM 2016;374:2222)