Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients?

F Blasi, G W Canonica, M Miravitlles

Research output: Contribution to journalReview article

Abstract

BACKGROUND: As 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 BODY: There 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.

CONCLUSION: In 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.

Original languageEnglish
Pages (from-to)19
JournalRespiratory Research
Volume18
Issue number1
DOIs
Publication statusPublished - Jan 18 2017

Fingerprint

Chronic Obstructive Pulmonary Disease
Muscarinic Antagonists
Bronchodilator Agents
Nebulizers and Vaporizers
Patient Selection
Therapeutics
Respiratory Therapy
Patient Preference
Bromides
Cholinergic Agents
Quality of Life
Clinical Trials
aclidinium bromide

Keywords

  • Administration, Inhalation
  • Adrenergic beta-2 Receptor Agonists
  • Bronchodilator Agents
  • Clinical Decision-Making
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Evidence-Based Medicine
  • Humans
  • Muscarinic Antagonists
  • Pulmonary Disease, Chronic Obstructive
  • Treatment Outcome
  • Tropanes
  • Journal Article
  • Review
  • Research Support, Non-U.S. Gov't

Cite this

Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients? / Blasi, F; Canonica, G W; Miravitlles, M.

In: Respiratory Research, Vol. 18, No. 1, 18.01.2017, p. 19.

Research output: Contribution to journalReview article

@article{f23b227880a14493a1afd4904e2ed03b,
title = "Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients?",
abstract = "BACKGROUND: As 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 BODY: There 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{\circledR} have been associated in clinical trials with higher patient preference.CONCLUSION: In 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.",
keywords = "Administration, Inhalation, Adrenergic beta-2 Receptor Agonists, Bronchodilator Agents, Clinical Decision-Making, Dose-Response Relationship, Drug, Drug Therapy, Combination, Evidence-Based Medicine, Humans, Muscarinic Antagonists, Pulmonary Disease, Chronic Obstructive, Treatment Outcome, Tropanes, Journal Article, Review, Research Support, Non-U.S. Gov't",
author = "F Blasi and Canonica, {G W} and M Miravitlles",
year = "2017",
month = "1",
day = "18",
doi = "10.1186/s12931-017-0506-0",
language = "English",
volume = "18",
pages = "19",
journal = "Respiratory Research",
issn = "1465-9921",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients?

AU - Blasi, F

AU - Canonica, G W

AU - Miravitlles, M

PY - 2017/1/18

Y1 - 2017/1/18

N2 - BACKGROUND: As 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 BODY: There 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.CONCLUSION: In 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.

AB - BACKGROUND: As 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 BODY: There 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.CONCLUSION: In 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.

KW - Administration, Inhalation

KW - Adrenergic beta-2 Receptor Agonists

KW - Bronchodilator Agents

KW - Clinical Decision-Making

KW - Dose-Response Relationship, Drug

KW - Drug Therapy, Combination

KW - Evidence-Based Medicine

KW - Humans

KW - Muscarinic Antagonists

KW - Pulmonary Disease, Chronic Obstructive

KW - Treatment Outcome

KW - Tropanes

KW - Journal Article

KW - Review

KW - Research Support, Non-U.S. Gov't

U2 - 10.1186/s12931-017-0506-0

DO - 10.1186/s12931-017-0506-0

M3 - Review article

C2 - 28100244

VL - 18

SP - 19

JO - Respiratory Research

JF - Respiratory Research

SN - 1465-9921

IS - 1

ER -