How do dual long-acting bronchodilators prevent exacerbations of chronic obstructive pulmonary disease?

Kai M. Beeh, Pierre Regis Burgel, Frits M.E. Franssen, Jose Luis Lopez-Campos, Stelios Loukides, John R. Hurst, Matjaž Fležar, Charlotte Suppli Ulrik, Fabiano Di Marco, Daiana Stolz, Arschang Valipour, Brian Casserly, Björn Ställberg, Konstantinos Kostikas, Jadwiga A. Wedzicha

Research output: Contribution to journalReview articlepeer-review

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 b2-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/inhaledcorticosteroids in decreasing exacerbation. These included effects on lung hyperinflation and mechanical stress, inflammation, excessive mucus productionwith impairedmucociliary clearance, and symptom severity. The data assembled and analyzed by each group were reviewed by all authors and combined into thismanuscript. 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.

Original languageEnglish
Pages (from-to)139-149
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume196
Issue number2
DOIs
Publication statusPublished - 15 Jul 2017
Externally publishedYes

Keywords

  • Hyperinflation
  • Inflammation
  • Inhaled corticosteroid
  • Mucus

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