Title |
How Do Dual Long-Acting Bronchodilators Prevent Exacerbations of Chronic Obstructive Pulmonary Disease?
|
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Published in |
American Journal of Respiratory & Critical Care Medicine, December 2016
|
DOI | 10.1164/rccm.201609-1794ci |
Pubmed ID | |
Authors |
Kai M Beeh, Pierre-Regis Burgel, Frits M E Franssen, Jose Luis Lopez-Campos, Stelios Loukides, John R Hurst, Matjaž Fležar, Charlotte Suppli Ulrik, Fabiano Di Marco, Daiana Stolz, Arschang Valipour, Brian Casserly, Björn Ställberg, Konstantinos Kostikas, Jadwiga A Wedzicha |
Abstract |
Decreasing the frequency and severity of exacerbations is one of the main goals of treatment for patients with chronic obstructive pulmonary disease (COPD). Several studies have documented that long-acting bronchodilators (LABDs) can reduce exacerbation rate and/or severity, and others have shown that combinations of long-acting 2-adrenergic agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) provide greater reductions in exacerbation frequency than either their monocomponents or LABA/inhaled corticosteroids (LABA/ICS) combinations in patients at low and high risk for these events. In this review, small groups of experts critically evaluated mechanisms potentially responsible for the increased benefit of LABA/LAMA combinations over single LABDs or LABA/ICS in decreasing exacerbation. These included effects on lung hyperinflation and mechanical stress, inflammation, excessive mucus production with impaired mucociliary clearance, and symptom severity. The data assembled and analyzed by each group were reviewed by all authors and combined into this manuscript. Available clinical results support the possibility that effects of LABA/LAMA combinations on hyperinflation, mucociliary clearance, and symptom severity may all contribute to decreasing exacerbations. While preclinical studies suggest LABAs and LAMAs have anti-inflammatory effects, such effects have not been demonstrated yet in patients with COPD. |
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Geographical breakdown
Country | Count | As % |
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United States | 9 | 13% |
Spain | 8 | 11% |
Venezuela, Bolivarian Republic of | 5 | 7% |
United Kingdom | 5 | 7% |
Canada | 3 | 4% |
Mexico | 2 | 3% |
Colombia | 2 | 3% |
India | 2 | 3% |
Greece | 1 | 1% |
Other | 8 | 11% |
Unknown | 25 | 36% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 48 | 69% |
Practitioners (doctors, other healthcare professionals) | 13 | 19% |
Scientists | 6 | 9% |
Science communicators (journalists, bloggers, editors) | 3 | 4% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Japan | 1 | 1% |
United States | 1 | 1% |
Unknown | 68 | 97% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 11 | 16% |
Researcher | 8 | 11% |
Student > Ph. D. Student | 7 | 10% |
Student > Postgraduate | 6 | 9% |
Professor | 5 | 7% |
Other | 9 | 13% |
Unknown | 24 | 34% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 28 | 40% |
Biochemistry, Genetics and Molecular Biology | 4 | 6% |
Pharmacology, Toxicology and Pharmaceutical Science | 3 | 4% |
Agricultural and Biological Sciences | 2 | 3% |
Unspecified | 1 | 1% |
Other | 3 | 4% |
Unknown | 29 | 41% |