An important step in simplifying asthma and chronic obstructive pulmonary disease (COPD) management and improving adherence with prescribed therapy is to reduce the dose frequency to the minimum necessary to maintain disease control. Therefore, the incorporation of once‐daily dose administration is an important strategy to improve adherence and is a regimen preferred by most patients, which may also lead to enhancement of compliance, and may have advantages leading to improved overall clinical outcomes. Once‐daily β₂‐agonists or ultra long‐acting β₂‐agonists (LABAs) such as carmoterol, indacaterol, GSK‐159797, GSK‐597901, GSK‐159802, GSK‐642444 and GSK‐678007 are under development for the treatment of asthma and COPD. Also some new long‐acting antimuscarinic agents (LAMAs) such as aclidinium, LAS‐35201, GSK656398, GSK233705, NVA‐237 (glycopyrrolate) and OrM3 are under development. In any case, the current opinion is that it will be advantageous to develop inhalers containing combination of several classes of long‐acting bronchodilator drugs in an attempt to simplify treatment regimens as much as possible. Consequently, several options for once‐daily dual‐action ultra LABA+LAMA combination products are currently being evaluated. A different approach is to have a dimer molecule in which both pharmacologies are present (these molecules are known as M₃ antagonist‐β₂ agonist (MABA) bronchodilators). The advent of a successful MABA product will revolutionize the field and open the door for a new range of combination products.

British Journal of Pharmacology (2008) 155, 291–299; doi:10.1038/bjp.2008.284; published online 7 July 2008