Optimizing bronchodilation in the prevention of COPD exacerbations

Detalhes bibliográficos
Autor(a) principal: Miravitlles, Marc
Data de Publicação: 2017
Outros Autores: Anzueto, Antonio, Jardim, Jose R. [UNIFESP]
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://dx.doi.org/10.1186/s12931-017-0601-2
https://repositorio.unifesp.br/handle/11600/53644
Resumo: The natural disease course of chronic obstructive pulmonary disease (COPD) is often punctuated by exacerbations: acute events of symptom worsening associated with significant morbidity and healthcare resource utilization
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spelling Optimizing bronchodilation in the prevention of COPD exacerbationsDual bronchodilationICSLABALAMATreatment guidelinesTriple therapyThe natural disease course of chronic obstructive pulmonary disease (COPD) is often punctuated by exacerbations: acute events of symptom worsening associated with significant morbidity and healthcare resource utilizationreduced quality of lifeand increased risk of hospitalization and death. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommend that patients at risk of exacerbations ( GOLD Groups C and D) receive a long-acting muscarinic antagonist (LAMA) or a long-acting beta(2)- agonist (LABA)/LAMA combination, respectively, as preferred initial treatments. The latter recommendation is based on recent trial evidence demonstrating the superior efficacy of a fixed-dose LABA/LAMA over an inhaled corticosteroid (ICS)/LABA in exacerbation prevention. ICS in combination with a LABA is also indicated for prevention of exacerbations, but the use of ICS is associated with an increased risk of adverse events such as pneumonia, and offers limited benefits beyond those provided by LABA or LAMA monotherapy. In this review, we examine evidence from a number of pivotal studies of LABAs and LAMAs, administered as monotherapy or as part of dual or triple combination therapy, with a specific focus on their effect on exacerbations. We also discuss a new proposed treatment paradigm for the management of COPD that takes into account this recent evidence and adopts a more cautious approach to the use of ICS. In alignment with GOLD 2017, we suggest that ICS should be reserved for patients with concomitant asthma or in whom exacerbations persist despite treatment with LABA/LAMA.Hosp Univ Vall dHebron, CIBER Enfermedades Resp CIBERES, Pneumol Dept, Barcelona, SpainUniv Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USASouth Texas Vet Hlth Care Syst, San Antonio, TX USAUniv Fed Sao Paulo, Escola Paulista Med, Resp Div, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Resp Div, Sao Paulo, BrazilWeb of ScienceNovartis Pharma AG (Basel, Switzerland)Novartis Pharma AG (Basel, Switzerland)Biomed Central Ltd2020-06-26T16:30:35Z2020-06-26T16:30:35Z2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion-application/pdfhttp://dx.doi.org/10.1186/s12931-017-0601-2Respiratory Research. London, v. 18, p. -, 2017.10.1186/s12931-017-0601-2WOS000405877600001.pdf1465-993Xhttps://repositorio.unifesp.br/handle/11600/53644WOS:000405877600001engRespiratory ResearchLondoninfo:eu-repo/semantics/openAccessMiravitlles, MarcAnzueto, AntonioJardim, Jose R. [UNIFESP]reponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-11T01:43:56Zoai:repositorio.unifesp.br/:11600/53644Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-11T01:43:56Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Optimizing bronchodilation in the prevention of COPD exacerbations
title Optimizing bronchodilation in the prevention of COPD exacerbations
spellingShingle Optimizing bronchodilation in the prevention of COPD exacerbations
Miravitlles, Marc
Dual bronchodilation
ICS
LABA
LAMA
Treatment guidelines
Triple therapy
title_short Optimizing bronchodilation in the prevention of COPD exacerbations
title_full Optimizing bronchodilation in the prevention of COPD exacerbations
title_fullStr Optimizing bronchodilation in the prevention of COPD exacerbations
title_full_unstemmed Optimizing bronchodilation in the prevention of COPD exacerbations
title_sort Optimizing bronchodilation in the prevention of COPD exacerbations
author Miravitlles, Marc
author_facet Miravitlles, Marc
Anzueto, Antonio
Jardim, Jose R. [UNIFESP]
author_role author
author2 Anzueto, Antonio
Jardim, Jose R. [UNIFESP]
author2_role author
author
dc.contributor.author.fl_str_mv Miravitlles, Marc
Anzueto, Antonio
Jardim, Jose R. [UNIFESP]
dc.subject.por.fl_str_mv Dual bronchodilation
ICS
LABA
LAMA
Treatment guidelines
Triple therapy
topic Dual bronchodilation
ICS
LABA
LAMA
Treatment guidelines
Triple therapy
description The natural disease course of chronic obstructive pulmonary disease (COPD) is often punctuated by exacerbations: acute events of symptom worsening associated with significant morbidity and healthcare resource utilization
publishDate 2017
dc.date.none.fl_str_mv 2017
2020-06-26T16:30:35Z
2020-06-26T16:30:35Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1186/s12931-017-0601-2
Respiratory Research. London, v. 18, p. -, 2017.
10.1186/s12931-017-0601-2
WOS000405877600001.pdf
1465-993X
https://repositorio.unifesp.br/handle/11600/53644
WOS:000405877600001
url http://dx.doi.org/10.1186/s12931-017-0601-2
https://repositorio.unifesp.br/handle/11600/53644
identifier_str_mv Respiratory Research. London, v. 18, p. -, 2017.
10.1186/s12931-017-0601-2
WOS000405877600001.pdf
1465-993X
WOS:000405877600001
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Respiratory Research
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv -
application/pdf
dc.coverage.none.fl_str_mv London
dc.publisher.none.fl_str_mv Biomed Central Ltd
publisher.none.fl_str_mv Biomed Central Ltd
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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