Abstract
BackgroundAs emphasized by international recommendations and largely confirmed by clinical experience, long-acting bronchodilators play a central role in the maintenance treatment of chronic obstructive pulmonary disease (COPD) due to their proven efficacy in reducing airflow obstruction and improving symptoms.Main bodyThere are some important aspects to define with regard to inhalation therapy for COPD, particularly those concerning the selection criteria and the optimal use of long-acting bronchodilators. First of all, it needs to be determined in which patients and clinical situations monotherapy with one bronchodilator, such as a long-acting muscarinic antagonist (LAMA), should be considered adequate, and in which cases the use of combination therapies, such as the “double bronchodilation” with a LAMA and a long-acting β2-agonist (LABA), should be preferred. Another critical issue concerns the effect of the frequency of daily administration of inhaled agents on the control of symptoms during the 24 h. COPD symptoms are known to exhibit considerable circadian variability with worsening in the early morning, and a significant proportion of patients have disease-related sleep disorders which can adversely affect their quality of life. The worsening of symptoms in the early morning may be due, at least in part, to a reduction in airway caliber caused by an increased “cholinergic tone” at night. As such, the coverage of nighttime and early morning symptoms is a reasonable therapeutic goal, which can be achieved by many patients using LAMAs such as aclidinium bromide twice daily (BID). Therapeutic adherence is known to be a multifactorial phenomenon that is frequently affected by other aspects than dosing frequency, including the technical features and ease of use of the inhalers. To this end, it should be mentioned that certain new-generation inhalers such as Genuair® have been associated in clinical trials with higher patient preference.ConclusionIn this work, in addition to presenting an overview of the main evidence on the efficacy of COPD treatment with the LAMA aclidinium bromide BID, we suggest some selection criteria for the monotherapy with one long-acting bronchodilator or the combination therapy with LAMA and LABA in COPD patients, with particular reference to specific clinical scenarios.
Highlights
Direct and indirect costs of chronic obstructive pulmonary disease (COPD) COPD involves a significant economic burden
In this work, in addition to presenting an overview of the main evidence on the efficacy of COPD treatment with the long-acting muscarinic antagonist (LAMA) aclidinium bromide bromide twice daily (BID), we suggest some selection criteria for the monotherapy with one long-acting bronchodilator or the combination therapy with LAMA and Long-acting β2-agonist (LABA) in COPD patients, with particular reference to specific clinical scenarios
The disability adjusted life years (DALYs) for a specific disease are calculated as the sum of the years of life lost due to premature mortality and the years of life lived with disability, adjusted for the severity of the disease
Summary
Bronchodilator therapy with LAMA, as monotherapy or in combination with LABA, is one cornerstone of COPD treatment. Given the circadian variability of symptoms in patients with COPD, due at least in part to the typical increased “cholinergic tone” in these subjects, the coverage of nighttime and early-morning symptoms should be considered a reasonable therapeutic target, which can be achieved by using an appropriate treatment (e.g. a LAMA such as aclidinium bromide, administered twice daily). Therapeutic adherence is often good in patients treated with twice-daily LAMAs, especially if they use a simple and easy-to-use inhalation device. The selection of LAMA monotherapy, combination therapy with LAMA + LABA, or add-on therapy with LAMA to LABA/ICS, should be individualized based on a comprehensive evaluation of the patient with COPD, taking into account the degree of airway obstruction, the symptom burden, eosinophil count, history of allergy and asthma and the frequency and type of exacerbations George’s Respiratory Questionnaire; TT: Triple therapy; VAChT: Vesicular acetylcholine transporter
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
