The potential mechanisms, by which bronchodilators may prevent exacerbations have been under discussion. Importantly, in COPD, bronchodilators can also effectively prevent exacerbations of the disease, as single agents or in combinations. Importantly, the combined use of two bronchodilators with different mechanism of action is considered an effective strategy to optimize bronchodilation in COPD, and there is now ample evidence for the improved clinical efficacy of fixed combinations of long-acting bronchodilators versus monotherapies or inhaled corticosteroid (ICS)/LABA combinations, in particular with regards to functional and symptomatic outcomes 8, 9, 10, 11. Both classes of agents have been demonstrated to be clinically effective, with acceptable safety profiles 7. To achieve bronchodilation, two classes of drugs are currently available, namely long-acting muscarinic antagonists (LAMA), and long-acting β2-agonists (LABA). Long-acting bronchodilators produce consistent improvements in lung function and patient-centred outcomes, including airflow (forced expiratory volume in 1 second), hyperinflation (inspiratory capacity or functional residual capacity), symptomatic control of dyspnea, health-related quality of life, exercise capacity, prevention of exacerbations, and, potentially, mortality in subsets of patients 1, 6, 7. While these events are somehow associated with the severity of COPD, the distribution of exacerbations in COPD is not uniform, with seasonal or temporal clustering 3, 4, in particular in a subset of COPD patients at high risk for exacerbations, where the individual history of prior exacerbations is the strongest single predictor of future events 5.Ĭurrent strategies recommend long-acting bronchodilators as first line maintenance therapy for symptomatic COPD 1. In this regard, a "frequent exacerbator" phenotype has been identified, and exacerbation risk is now used to classify COPD patients according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy paper (GOLD groups C and D, subjects with a history of 2 moderate, or one severe hospitalized exacerbation in the past years) 1.Įxacerbations are considered key events in the clinical course of COPD, and the prevention of exacerbations is highlighted as a pivotal therapeutic goal and relevant outcome measure by current treatment strategies or guidelines. It is, however, increasingly recognized, that distinct COPD phenotypes exist, and these may be prone to a more personalized, "targetted" management approach 2. The term chronic obstructive pulmonary disease (COPD) has been established as an umbrella term to label a clinical syndrome characterized by chronic, poorly reversible airflow obstruction, airway inflammation in the presence of chronic bronchitis and/or pulmonary emphysema 1. This review summarizes the current data on clinical effectiveness of bronchodilators alone or in combination to prevent exacerbations of COPD.
#Lama drugs plus
These agents show superior symptom control to monotherapies, and some of these combinations have also demonstrated superior efficacy in exacerbation prevention versus monotherapies, or combinations of inhaled corticosteroids plus LABA.
Several novel LAMA/LABA fixed dose combination inhalers are currently approved for COPD maintenance treatment. In contrast to asthma management, evidence supports the efficacy of both classes of long-acting bronchodilators as monotherapy in preventing COPD exacerbations, with greater efficacy of LAMA drugs versus LABAs. Bronchodilators are classified into two classes based on distinct modes of action, i.e., long-acting antimuscarinics (LAMA, once-daily and twice-daily), and long-acting β2-agonists (LABA, once-daily and twice-daily). They are routinely recommended for symptom reduction, with a preference of long-acting over short-acting drugs. Bronchodilators are the cornerstone of symptomatic chronic obstructive pulmonary disease (COPD) treatment.
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