The impact of long-acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease: a systematic review
Patients suffering from chronic obstructive pulmonary disease (COPD) clinically manifest airway mucus hypersecretion as sputum expectoration and cough. Evidence accumulated in the past decade has shown that the cholinergic system not only regulates airway smooth muscle contraction but also the activ...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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European Respiratory Society
2022-05-01
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| Series: | European Respiratory Review |
| Online Access: | http://err.ersjournals.com/content/31/164/210196.full |
| _version_ | 1811225248782090240 |
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| author | Luigino Calzetta Beatrice Ludovica Ritondo Maria Cristina Zappa Gian Marco Manzetti Andrea Perduno Janis Shute Paola Rogliani |
| author_facet | Luigino Calzetta Beatrice Ludovica Ritondo Maria Cristina Zappa Gian Marco Manzetti Andrea Perduno Janis Shute Paola Rogliani |
| author_sort | Luigino Calzetta |
| collection | DOAJ |
| description | Patients suffering from chronic obstructive pulmonary disease (COPD) clinically manifest airway mucus hypersecretion as sputum expectoration and cough. Evidence accumulated in the past decade has shown that the cholinergic system not only regulates airway smooth muscle contraction but also the activity of inflammatory and airway epithelial cells, including goblet cells, and submucosal gland activity. Long-acting muscarinic antagonists (LAMAs) with the most favourable M3/M2 muscarinic acetylcholine (ACh) receptors residency properties are not only excellent bronchodilators but potentially also mucus-modifying agents, able to positively impact on mucus hypersecretion and cough. The aim of this systematic review was to investigate the impact of LAMAs on mucus hypersecretion and cough in COPD patients. The evidence confirmed that LAMAs, mainly tiotropium and aclidinium, improved sputum production and cough in moderate to severe COPD. Thus, LAMAs not only antagonise the ACh-induced bronchoconstriction of the airways but also appear to limit the production of mucus secreted in response to ACh by airway goblet cells and/or submucosal glands. Further clinical studies are necessary to evaluate the impact of LAMAs exclusively on sputum symptoms and cough as primary end-points and to investigate whether LAMAs have a modulatory action on the rheological properties of mucus. |
| first_indexed | 2024-04-12T09:03:58Z |
| format | Article |
| id | doaj.art-8ab3fb3f30fa4540969d1ac1860a7a0b |
| institution | Directory Open Access Journal |
| issn | 0905-9180 1600-0617 |
| language | English |
| last_indexed | 2024-04-12T09:03:58Z |
| publishDate | 2022-05-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | European Respiratory Review |
| spelling | doaj.art-8ab3fb3f30fa4540969d1ac1860a7a0b2022-12-22T03:39:09ZengEuropean Respiratory SocietyEuropean Respiratory Review0905-91801600-06172022-05-013116410.1183/16000617.0196-20210196-2021The impact of long-acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease: a systematic reviewLuigino Calzetta0Beatrice Ludovica Ritondo1Maria Cristina Zappa2Gian Marco Manzetti3Andrea Perduno4Janis Shute5Paola Rogliani6 Dept of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy Unit of Respiratory Medicine, Dept of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy Pulmonology Dept, Sandro Pertini Hospital, Rome, Italy Unit of Respiratory Medicine, Dept of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy Unit of Respiratory Medicine, Dept of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK Unit of Respiratory Medicine, Dept of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy Patients suffering from chronic obstructive pulmonary disease (COPD) clinically manifest airway mucus hypersecretion as sputum expectoration and cough. Evidence accumulated in the past decade has shown that the cholinergic system not only regulates airway smooth muscle contraction but also the activity of inflammatory and airway epithelial cells, including goblet cells, and submucosal gland activity. Long-acting muscarinic antagonists (LAMAs) with the most favourable M3/M2 muscarinic acetylcholine (ACh) receptors residency properties are not only excellent bronchodilators but potentially also mucus-modifying agents, able to positively impact on mucus hypersecretion and cough. The aim of this systematic review was to investigate the impact of LAMAs on mucus hypersecretion and cough in COPD patients. The evidence confirmed that LAMAs, mainly tiotropium and aclidinium, improved sputum production and cough in moderate to severe COPD. Thus, LAMAs not only antagonise the ACh-induced bronchoconstriction of the airways but also appear to limit the production of mucus secreted in response to ACh by airway goblet cells and/or submucosal glands. Further clinical studies are necessary to evaluate the impact of LAMAs exclusively on sputum symptoms and cough as primary end-points and to investigate whether LAMAs have a modulatory action on the rheological properties of mucus.http://err.ersjournals.com/content/31/164/210196.full |
| spellingShingle | Luigino Calzetta Beatrice Ludovica Ritondo Maria Cristina Zappa Gian Marco Manzetti Andrea Perduno Janis Shute Paola Rogliani The impact of long-acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease: a systematic review European Respiratory Review |
| title | The impact of long-acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease: a systematic review |
| title_full | The impact of long-acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease: a systematic review |
| title_fullStr | The impact of long-acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease: a systematic review |
| title_full_unstemmed | The impact of long-acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease: a systematic review |
| title_short | The impact of long-acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease: a systematic review |
| title_sort | impact of long acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease a systematic review |
| url | http://err.ersjournals.com/content/31/164/210196.full |
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