Effectiveness of glycopyrronium bromide in the treatment of small airways dysfunction

Abstract

Introduction: Glycopyrronium bromide (GB) is an antimuscarinic compound,exerts its action by inhibiting bronchoconstriction,mainly blocking M3 and M1 muscarinic receptors.The damage caused by inhalation of toxic particles such as cigarette smoke and environmental pollutants, affects the small airways. Aim of the study: We tried to verify if there is a relationship between alterations of small airways and efficacy of bronchodilation evaluated using GB;exercise tolerance was assessed by perfoming the walking test (WT). Methods: We selected 42 patients (24 female/ 18 male), with: mean age 66.8 ± 9.7;normal FEV1/FVC ratio % 77.45 ± 4.86; reduced FEF 25-75% 42.9 ± 10.50; increased RV/TLC ratio % (dynamic hyperinflation index) 132.66 ± 6.41; FEV1 1.85 ± 0.54 liters; FVC 2.39±0.71 liters; SR tot (airway resistance) 168.10 ± 42.53 KPa*S;TLC 98.26 ± 8.94 liters;WT 318.39 ± 36.60 meter;MMRC dypnea scale 1.48 ± 0.77.Patients were treated with GB and underwent a second visit after 4 months. Results: After the treatment, a significant improvement was recorded regarding FVC (P=0.04),FEV1/FVC ratio % (P=0.01), FEF 25-75 % (P Conclusions: In this real life experience, GB has proven to exert favourable effects on lung hyperinflation,with positive reflexes also in measurable functional parameters, such as dyspnea and exercise capacity.In this setting,small airways dysfunction has been successfully managed by an anticholinergic agent.