Review article

Inhaled Pharmacologic Therapy for Treatment of Stable Chronic Obstructive Pulmonary

Gordana Pavliša
Petra Hodak
Bea Hohšteter
Marina Lampalo
Andrea Vukić Dugac
Miroslav Samaržija

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow obstruction caused by chronic inflammatory response of the airways and the lung parenchyma to noxious particles or gases. The main goals of pharmacologic therapy are to reduce symptoms and the frequency and severity of exacerbations as well as to improve exercise tolerance and health status. The mainstays of drug therapy of stable symptomatic COPD are inhaled bronchodilators (beta-agonists and anticholinergics) alone or in combination with inhaled corticosteroids (ICS). Regular use of long-acting bronchodilators is recommended for the management of patients with persistent symptoms. Compared to placebo, long-acting bronchodilators significantly improve lung function and health-related quality of life while reducing exacerbation rates. Overall, long-acting muscarinic antagonists (LAMAs) lead to greater improvement in lung function parameters, reduction in acute exacerbation rates and fewer adverse effects compared with long-acting beta-2 agonists (LABAs). In patients whose disease is not sufficiently controlled with monotherapy, guidelines recommended combination therapy involving two long-acting bronchodilators with differing modes of action. Compared with monotherapy, LAMA/LABA combination therapy significantly improves lung function, symptoms and health status. The safety profile of the LAMA/LABA combination therapy is similar to the safety profiles of LABAs and LAMAs when administered as monotherapy. In patients prone to exacerbations, an ICS combined with LABA is more effective than either component alone in improving lung function, health status and reducing exacerbations. In patients with severe to very severe COPD and increased exacerbation risk, triple therapy consisting of ICS, LABAs and LAMAs additionally improves lung function, reduces exacerbation rates and dyspnea compared to ICS/LABA combination therapy.

Keywords

chronic obstructive pulmonary disease; long-acting muscarinic antagonists; long-acting beta-2 agonists, inhaled corticosteroids

Hrčak ID:

214615

URI

https://hrcak.srce.hr/214615

Publication date:

31.10.2018.

Article data in other languages: croatian

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