JAMA Intern Med

Dry powder dual therapy: Fewer flare‑ups—and easier on the environment?

February 26, 2026

This large cohort study compared three dual bronchodilator inhalers among adults newly starting treatment for COPD. The work was partly motivated by the higher greenhouse gas emissions associated with metered‑dose inhalers compared with dry powder or soft‑mist devices. Once‑daily umeclidinium with vilanterol was associated with a modest reduction in moderate or severe exacerbations compared with two alternative inhalers, while safety outcomes were similar across groups.

Key hazard ratios (HRs) for first moderate or severe exacerbation:

• Umeclidinium + vilanterol vs. glycopyrrolate + formoterol: HR, 0.86 (95% confidence interval [CI], 0.81–0.91)
• Umeclidinium + vilanterol vs. tiotropium + olodaterol: HR, 0.97 (95% CI, 0.94–0.99)
• Tiotropium + olodaterol vs. glycopyrrolate + formoterol: HR, 0.94 (95% CI, 0.89–1.00)

Risks of major cardiovascular events, UTI, and pneumonia hospitalization were similar across all comparisons.

Clinical takeaway: Clinicians may consider dry powder umeclidinium with vilanterol for new therapy starts, given its modestly lower exacerbation risk and the lower emissions profile associated with dry powder devices.

Source:

Portela GT, et al. (2026, February 23). JAMA Intern Med. Comparative Effectiveness and Safety of LAMA-LABA Inhalers in Chronic Obstructive Pulmonary Disease. https://pubmed.ncbi.nlm.nih.gov/41729543/