PT - JOURNAL ARTICLE AU - Dave Singh AU - James F. Donohue AU - Isabelle H. Boucot AU - Neil C. Barnes AU - Chris Compton AU - Fernando J. Martinez TI - Future concepts in bronchodilation for COPD: dual- <em>versus</em> monotherapy AID - 10.1183/16000617.0023-2021 DP - 2021 Jun 30 TA - European Respiratory Review PG - 210023 VI - 30 IP - 160 4099 - http://err.ersjournals.com/content/30/160/210023.short 4100 - http://err.ersjournals.com/content/30/160/210023.full SO - EUROPEAN RESPIRATORY REVIEW2021 Jun 30; 30 AB - Most patients with COPD are recommended to initiate maintenance therapy with a single long-acting bronchodilator, such as a long-acting muscarinic antagonist or long-acting β2-agonist. However, many patients receiving mono-bronchodilation continue to experience high symptom burden, suggesting that patients are frequently not receiving optimal treatment. Treatment goals for COPD are often broad and not individually tailored, making initial treatment response assessments difficult. A personalised approach to initial maintenance therapy, based upon an individual's symptom burden and exacerbation risk, may be more appropriate.An alternative approach would be to maximise bronchodilation early in the disease course of all patients with COPD. Evidence suggests that dual bronchodilation has greater and consistent efficacy for lung function and symptoms than mono-bronchodilation, whilst potentially reducing the risk of exacerbations and disease deterioration, with a similar safety profile to mono-bronchodilators. Improvements in lung function and symptoms between dual- and mono-bronchodilation have also been demonstrated in maintenance-naïve patients, who are most likely to resemble those at first presentation in a clinical setting. Despite promising results, there are several evidence gaps that need to be addressed to allow decision makers to evaluate the merits of a widespread earlier introduction of dual bronchodilation.Many patients with COPD experience debilitating symptoms even when using a single bronchodilator. Intensifying treatment with dual bronchodilation as early as possible may improve outcomes for patients with COPD. https://bit.ly/3myMtzp