Future concepts in bronchodilation for COPD: dual-versusmonotherapy

Abstract

Most patients with COPD are recommended to initiate maintenance therapy with a single long-acting bronchodilator, such as a long-acting muscarinic antagonist or long-acting β2-agonist. However, many patients receiving mono-bronchodilation continue to experience high symptom burden, suggesting that patients are frequently not receiving optimal treatment. Treatment goals for COPD are often broad and not individually tailored, making initial treatment response assessments difficult. A personalised approach to initial maintenance therapy, based upon an individual's symptom burden and exacerbation risk, may be more appropriate.An alternative approach would be to maximise bronchodilation early in the disease course of all patients with COPD. Evidence suggests that dual bronchodilation has greater and consistent efficacy for lung function and symptoms than mono-bronchodilation, whilst potentially reducing the risk of exacerbations and disease deterioration, with a similar safety profile to mono-bronchodilators. Improvements in lung function and symptoms between dual- and mono-bronchodilation have also been demonstrated in maintenance-naïve patients, who are most likely to resemble those at first presentation in a clinical setting. Despite promising results, there are several evidence gaps that need to be addressed to allow decision makers to evaluate the merits of a widespread earlier introduction of dual bronchodilation.

Differential Response to 12 Weeks of Once-Daily Tiotropium/Olodaterol Fixed Dose Combination in Patients with COPD: A Multidimensional Response Profiling in the TORRACTO Study

“…17,18 Studying a set of different effects simultaneously in the pharmacological management of COPD has also been encouraged in several reviews and statements since the relationship between spirometry and symptoms appears to be modest. [19][20][21] Moreover, recently, a multicomponent measure for assessing disease worsening in COPD has been studied in the IMPACT trial. 22 Han et al demonstrated that prevention of clinically important deterioration (defined as any of the following on-treatment events: moderate/severe exacerbation, deterioration in lung function or deterioration in health status) is likely to reduce future risks of exacerbations requiring hospitalization and all-cause mortality.…”

Terapêutica farmacológica inalada da DPOC nos cuidados de saúde primários: uma visão integrada

“…A dupla broncodilatação LAMA/LABA, em comparação com a monoterapia com LAMA ou LABA, e para um perfil de segurança similar, demonstra maior eficácia com superior melhoria da função pulmonar, redução dos sintomas, do número de agudizações, de hospitalizações e da deterioração clínica. 1,6,[8][9][10] A dupla broncodilatação é a terapêutica de primeira linha em doentes sintomáticos ou com intolerância ao exercício e nos doentes com classificação GOLD B e E. As opções de terapêutica combinada em associação fixa atualmente disponíveis são: o aclidínio/formoterol (ge-nuair®), o glicopirrónio/indacaterol (breezhaler®), o tiotrópio/olodaterol (respimat®), o umeclidínio/vilanterol (ellipta®) e o glicopirrónio/formoterol (aeros-phere®).…”

Pharmacotherapeutic strategy for COPD patients: focus on dual bronchodilators

“…Таким образом, сегодня мы располагаем многочисленными свидетельствами того, что фиксированные комбинации ДДБА/ДДХБ обеспечивают оптимальную бронходилатацию и играют первостепенную роль в предотвращении обострений ХОБЛ. Превосходя плацебо и активный контроль (ДДБА, ДДХБ, ИГКС/ДДБА), комбинированные бронходилататоры могут отличаться по своему терапевтическому потенциалу, хотя имеющаяся доказательная база (неравнозначная по числу, масштабу и дизайну исследований), в т. ч. и единичные прямые сравнительные исследования, не позволяет сделать в каждом конкретном случае однозначный выбор в пользу той или иной фиксированной комбинации ДДБА/ДДХБ [24][25][26][27].…”