Arformoterol: rationale for use in chronic obstructive pulmonary disease

2014 Long-acting β-agonists (LABAs) are the standard of care for chronic obstructive pulmonary disease (COPD) patients with advanced disease, those with mild to moderate disease and frequent exacerbations or those with significant dyspnea. Currently available LABAs include salmeterol, formoterol, indacaterol, vilanterol and olodaterol. The bronchodilatory effect of LABAs is mediated via the binding and ligation of the β2–adrenergic receptor and the lipophilic nature of the LABA compound accounts for their long duration of action. LABAs are available as hand held devices, either as a single agent or combined with a corticosteroid. Proper inhaler technique is necessary for adequate drug delivery but is often difficult to achieve in older patients with significant impairment in cognition, dexterity or ability to generate adequate inspiratory flow rates. Arformoterol, which is an (R,R) enantiomer of formoterol, is available as a nebulized solution and is clinically equivalent to formoterol or salmeterol. Arformoterol as a nebulized solution provides an alternative to device-based LABAs in select patients.