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

Am J Respir Crit Care Med 2017 07;196(2):139-149

17 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom.

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 β-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.

Download full-text PDF

Source
http://dx.doi.org/10.1164/rccm.201609-1794CIDOI Listing
July 2017
75 Reads

Publication Analysis

Top Keywords

long-acting bronchodilators
12
chronic obstructive
12
obstructive pulmonary
12
laba/lama combinations
8
patients chronic
8
clearance symptom
8
pulmonary disease
8
mucociliary clearance
8
symptom severity
8
review small
4
events review
4
clinical support
4
support possibility
4
high risk
4
risk events
4
manuscript clinical
4
groups experts
4
critically evaluated
4
authors combined
4
experts critically
4

References

(Supplied by CrossRef)

Anzueto A et al.
Int J Chron Obstruct Pulmon Dis 2009

Similar Publications