DPIs Outperform MDIs for COPD Patients

A study published in JAMA Internal Medicine suggests that environmentally friendly dry powder inhalers (DPIs) in the combined LAMA-LABA class may yield better outcomes for COPD patients than traditional propellant-driven metered-dose inhalers (MDIs).

The UCLA study analyzed insurance claims for adults aged 40 and older newly prescribed one of three common COPD inhalers: a DPI containing umeclidinium-vilanterol, an MDI containing glycopyrrolate-formoterol, or a soft mist inhaler containing tiotropium-olodaterol.

All the participants were enrolled in a large commercial or Medicare Advantage health plan and were matched into comparison groups based on the type of inhaler they were prescribed. The investigators then looked at how long they went before they developed their first moderate or severe COPD exacerbation. Outcomes such as heart events, urinary tract infections, and pneumonia hospitalizations were also tracked.

They found that the DPI was associated with a 14% lower risk of moderate or severe COPD exacerbations when compared to the MDI. The soft mist inhaler was associated with a 6% lower risk vs. the MDI. No significant differences were seen in major cardiovascular events, urinary tract infections, or pneumonia across the three inhaler types.

Since DPIs are already known to be better for the environment, the authors believe these findings suggest patients, prescribers, and health systems may want to choose once-daily umeclidinium-vilanterol dry powder inhalers over alternatives for their patients who require LAMA-LABA therapy.

“This combination makes a strong case for using the dry powder inhaler when possible,” said study author William Feldman. “Although some patients may require MDIs, dry powder inhalers, and soft mist inhalers are a safe and effective option for most patients with COPD.” 

Highlighted in RC Buzz March 16, 2026