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Issue 12, 2010
HOT TOPICS IN RESPIRATORY MEDICINE
Optimizing bronchodilation in chronic obstructive pulmonary disease: is it possible?
| Publ. date: | 2010 |
| ISBN: | 978-88-6450-034-8 |
| ISSN: | 1973-9664 |
| E-ISSN: | 2036-0886 |
| DOI: | 10.4147/HTR-091200 |
Abstract
International guidelines on chronic obstructive pulmonary disease (COPD) emphasize the clinical benefit derived from including long-acting bronchodilators (LABDs) in their therapeutic approach. Long-acting agents, particularly once-daily inhalers, will offer greater adherence than other drugs that require a more complicated dosing schedule. In this context, Baloira describes indacaterol, one of the new once-daily inhaled beta2-adrenoreceptor agonists (LABAs) that have completed phase II and phase III clinical trials for the treatment of COPD. Based on clinical trials conducted to date, the author reviews its pharmacological properties and bronchodilator efficacy, as well as its security profile.
The chapter by Cazzola stresses that bronchodilators improve airflow limitation observed in patients with COPD by producing airway smooth-muscle relaxation, although beta2-agonists and anticholinergics achieve this effect through different mechanisms. In this sense, the author defends the combination of an LABA and a long-acting muscarinic agent as an innovative approach that will most likely be a significant therapeutic advance in a selected population of patients with airflow obstruction. To some extent, reviews of the most important studies describing combination therapy, either with short-acting bronchodilators or LABDs, emphasize maximal bronchodilator capacity of patients with COPD. Cazzola enhances the functional impact of LABDs and describes a variety of emerging combinations that are currently undergoing development, with the hope of achieving once-daily dosing. O’Donnell et al then analyzes physiopathological concepts, such as airflow reversibility or pulmonary hyperinsuflation, and their relation to such clinical phenomena as dyspnea, exercise intolerance, and impairment of daily routine and quality of life, which might be approached obtaining maximal brochodilation. Soler-Cataluña points out other clinical benefits secondary to achieving maximal bronchodilation, especially the impact in reducing exacerbation rate and mortality.
Table of contents
Foreword
All guidelines now recognize that the initial treatment of patients with symptomatic chronic obstructive pulmonary disease (COPD) must be the administration of a long-acting bronchodilator (LABD). Today it is difficult to justify treatment with short-acting bronchodilators as the first option in COPD, even in mild cases. This is based on the current evidence that LABDs provide relief of symptoms, improve lung function, reduce exacerbations, improve health status, and may even improve survival.
However, the ceiling of the bronchodilator effect is not yet established. Some studies suggest that combining LABDs with different mechanisms of action will result in additive benefits; however, only short-term studies are available. In this context, the development of the new ultra-long-acting beta2-agonist, indacaterol, will provide a better and more convenient alternative to the existing twice daily beta2-agonists and will be considered as a first-line bronchodilator therapy in COPD.
The future trend in the treatment of COPD will, undoubtedly, be to use drugs in a single daily administration to ensure maximum compliance. It should be taken into account that most patients are elderly, with multiple medications, and the treatment is indefinite in length. Once-daily bronchodilators, alone or in combination, will be the basis of the treatment, and the inhaled corticosteroids (ICS) are useful in the group of patients with well-defined characteristics. The latest studies indicate that the benefits of ICS are limited in COPD and the risks are not insignificant, therefore their use should remain limited to "responder" patients and should always be administered in association with a long-acting beta2-bronchodilator. There is no longer one treatment for COPD but rather, similar to what occurs with other chronic diseases such as hypertension or diabetes, different therapeutic options should be individualized based on the characteristics of each patient.
ARTICLES
Indacaterol, a new ultra-long-acting bronchodilator for chronic obstructive pulmonary disease
Adolfo Baloira Villar
How to obtain maximal bronchodilation in chronic obstructive pulmonary disease
Mario Cazzola
Clinical benefits of maximal bronchodilation in chronic obstructive pulmonary disease (Part I)
Pierantonio Laveneziana, Denis E. O’Donnell, Josuel Ora
Clinical benefits of maximal bronchodilation in chronic obstructive pulmonary disease (Part II)
Miguel Á. Martínez García, Juan J. Soler-Cataluña
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Editor-in-chief
Marc Miravitlles - MD
Over the last 15 years there has been a decrease in mortality due to preventable diseases, with the exception of chronic obstructive pulmonary disease (COPD), which is an example that highlights the r...
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