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LABA/LAMA Dual Bronchodilator — COPD

Indacaterol / Glycopyrronium

Brand names: Ultibro Breezhaler

A fixed-dose maintenance inhaler pairing the long-acting beta-2 agonist indacaterol with the long-acting antimuscarinic glycopyrronium for COPD. It provides once-daily dual bronchodilation and is not intended for acute symptom relief.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Indacaterol activates beta-2 receptors to relax airway smooth muscle, and glycopyrronium antagonises muscarinic receptors to oppose cholinergic bronchoconstriction, delivering complementary bronchodilation.

Prescribing in practice

  • It is a preventer, not a reliever — patients must keep a separate short-acting inhaler for breakthrough symptoms and never use this for acute attacks.
  • Use with caution in significant cardiovascular disease, arrhythmias, narrow-angle glaucoma and bladder outflow obstruction given the combined beta-agonist and antimuscarinic effects.
  • Check device technique and suitability at initiation and review, as poor technique undermines efficacy.

Monitoring

Review breathlessness, exacerbation rate and inhaler technique, monitoring for tremor or palpitations and for antimuscarinic effects such as dry mouth and urinary difficulty.

Counselling the patient

  • Use this every day to prevent symptoms; keep your reliever inhaler for sudden breathlessness.
  • Report palpitations, eye pain or trouble passing urine.

Evidence & guidelines

Dual LABA/LAMA therapy is recommended by NICE and GOLD for COPD with continued symptoms or exacerbations despite monotherapy.

Reference: FLAME Trial (Wedzicha et al. NEJM 2016); GOLD 2024; NICE NG115; SPC Ultibro Breezhaler; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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