How Do Dual Long-Acting Bronchodilators Prevent Exacerbations of Chronic Obstructive Pulmonary Disease?

Abstract

Word Count: 187 At-a-Glance CommentaryResults from multiple clinical trials have demonstrated that fixed combinations of long-acting β-adrenergic agonists (LABA) and long-acting muscarinic antagonists (LAMA) are significantly superior to their monocomponents and to the combination LABA and an inhaled corticosteroid in decreasing the frequency of exacerbations in patients with chronic obstructive pulmonary disease. At present, the mechanism(s) underlying this clinical benefit are not fully understood.This review considers potential mechanisms whereby LABA/LAMA combinations might exert additive or synergistic effects that lead to a decrease in exacerbations. Mechanisms considered include effects on lung hyperinflation and mechanical stress, inflammation, excessive mucus production with impaired mucociliary clearance, and symptom severity and variability. Word count: 188

GOLD 2017 on the way to a phenotypic approach? Analysis from the Phenotypes of COPD in Central and Eastern Europe (POPE) Cohort

“…However, the decision for introducing other recommended treatments (roflumilast, ICS, azithromycin) is most likely to be based on phenotype (chronic bronchitis, ACOS, chronic infection) in addition to CAT scores and dyspnoea. As shown in our present study, accurate adherence to the new GOLD 2017 Report will likely promote dual bronchodilator treatments as the core gold standard therapy for majority of patients with COPD, significantly narrowing the use of ICS [11,12].…”

Long-term safety and efficacy of glycopyrrolate/formoterol metered dose inhaler using novel Co-Suspension™ Delivery Technology in patients with chronic obstructive pulmonary disease

“…Adverse event a , n (%) GFF MDI bronchodilation utilized by glycopyrronium (LAMA) and formoterol (LABA) [2,40].…”

Possibilities to prevent acute exacerbation of chronic obstructive pulmonary disease using inhalational therapy. A Report of Expert Panel of Russian Respiratory Society

“…Механизм снижения риска обострений ХОБЛ при терапии бронходилататорами длительного действия может быть связан с их воздействием на легочную гиперинфляцию, стабилизацию дыхательных путей, секрецию и клиренс мокроты (особенно при использовании ДДАХП), или просто с повышением функционального резерва. Примечательно, что достоверное снижение частоты обострений ХОБЛ (на 30 %) наблюдается и после хирургической редукции объема легких [43], т. е. вмешательства, не об ладающие прямым противовоспалительным действием, могут предупреждать обострения только за счет положительных изменений биомеханики дыхания [44].…”