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Title: How Do Dual Long-Acting Bronchodilators Prevent Exacerbations of Chronic Obstructive Pulmonary Disease?
Authors: Beeh, Kai M
Burgel, Pierre-Regis
Franssen, Frits M E
Lopez-Campos, Jose Luis
Loukides, Stelios
Hurst, John R
Fležar, Matjaž
Ulrik, Charlotte Suppli
Di Marco, Fabiano
Stolz, Daiana
Valipour, Arschang
Casserly, Brian
Ställberg, Björn
Kostikas, Konstantinos
Wedzicha, Jadwiga A
Keywords: hyperinflation;inflammation;inhaled corticosteroid;mucus
metadata.dc.subject.mesh: Administration, Inhalation
Adrenergic beta-2 Receptor Agonists
Bronchodilator Agents
Drug Therapy, Combination
Muscarinic Antagonists
Pulmonary Disease, Chronic Obstructive
Issue Date: 2017
Abstract: Decreasing the frequency and severity of exacerbations is one of the main goals of treatment for patients with chronic obstructive pulmonary disease. Several studies have documented that long-acting bronchodilators can reduce exacerbation rate and/or severity, and others have shown that combinations of long-acting β2-adrenergic agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) provide greater reductions in exacerbation frequency than either their monocomponents or LABA/inhaled corticosteroid combinations in patients at low and high risk for these events. In this review, small groups of experts critically evaluated mechanisms potentially responsible for the increased benefit of LABA/LAMA combinations over single long-acting bronchodilators or LABA/inhaled corticosteroids in decreasing exacerbation. These included effects on lung hyperinflation and mechanical stress, inflammation, excessive mucus production with impaired mucociliary clearance, and symptom severity. The data assembled and analyzed by each group were reviewed by all authors and combined into this manuscript. Available clinical results support the possibility that effects of LABA/LAMA combinations on hyperinflation, mucociliary clearance, and symptom severity may all contribute to decreasing exacerbations. Although preclinical studies suggest LABAs and LAMAs have antiinflammatory effects, such effects have not been demonstrated yet in patients with chronic obstructive pulmonary disease.
metadata.dc.identifier.doi: 10.1164/rccm.201609-1794CI
Appears in Collections:Producción 2020

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