Aclidinium bromide with formoterol

How it works

Aclidinium blocks M3 muscarinic receptors while formoterol stimulates beta-2 adrenoceptors, together relaxing airway smooth muscle through complementary pathways for greater bronchodilation. Formoterol additionally has a relatively rapid onset.

Prescribing in practice

• The antimuscarinic component can trigger acute angle-closure glaucoma and urinary retention while the beta-2 agonist can cause tachycardia, tremor and hypokalaemia — counsel on glaucoma and urinary warning signs as the key caution and use cautiously in cardiovascular disease.
• It is maintenance therapy only and must not be relied on for acute symptom relief; ensure a separate short-acting reliever is available.
• Hypokalaemia risk is increased by concomitant corticosteroids, diuretics or xanthines, and paradoxical bronchospasm warrants immediate discontinuation.

Monitoring

Monitor symptom control, exacerbations, heart rate and inhaler technique, with attention to antimuscarinic and beta-agonist adverse effects.

Counselling the patient

• Take regularly to prevent symptoms, not to treat a sudden flare-up.
• Report palpitations, tremor, eye pain or difficulty passing urine.
• Maintain correct dry-powder inhaler technique at each use.

Evidence & guidelines

Trials of the LAMA/LABA combination demonstrate greater improvement in lung function and breathlessness than either component alone, in line with NICE dual-bronchodilator recommendations for COPD.