When is dual bronchodilation indicated in COPD?
Mike Thomas,1 David MG Halpin,2 Marc Miravitlles3 1Primary Care and Population Sciences, University of Southampton, Southampton, 2Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK; 3Pneumology Department, Hospital Universitari Vall d’Hebron, Centro de Investi...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2017-08-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/when-is-dual-bronchodilation-indicated-in-copd-peer-reviewed-article-COPD |
| _version_ | 1811332920160288768 |
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| author | Thomas M Halpin DMG Miravitlles M |
| author_facet | Thomas M Halpin DMG Miravitlles M |
| author_sort | Thomas M |
| collection | DOAJ |
| description | Mike Thomas,1 David MG Halpin,2 Marc Miravitlles3 1Primary Care and Population Sciences, University of Southampton, Southampton, 2Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK; 3Pneumology Department, Hospital Universitari Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain Abstract: Inhaled bronchodilator medications are central to the management of COPD and are frequently given on a regular basis to prevent or reduce symptoms. While short-acting bronchodilators are a treatment option for people with relatively few COPD symptoms and at low risk of exacerbations, for the majority of patients with significant breathlessness at the time of diagnosis, long-acting bronchodilators may be required. Dual bronchodilation with a long-acting β2-agonist and long-acting muscarinic antagonist may be more effective treatment for some of these patients, with the aim of improving symptoms. This combination may also reduce the rate of exacerbations compared with a bronchodilator-inhaled corticosteroid combination in those with a history of exacerbations. However, there is currently a lack of guidance on clinical indicators suggesting which patients should step up from mono- to dual bronchodilation. In this article, we discuss a number of clinical indicators that could prompt a patient and physician to consider treatment escalation, while being mindful of the need to avoid unnecessary polypharmacy. These indicators include insufficient symptomatic response, a sustained increased requirement for rescue medication, suboptimal 24-hour symptom control, deteriorating symptoms, the occurrence of exacerbations, COPD-related hospitalization, and reductions in lung function. Future research is required to provide a better understanding of the optimal timing and benefits of treatment escalation and to identify the appropriate tools to inform this decision. Keywords: COPD, dual bronchodilation, monobronchodilation, ICS, triple therapy |
| first_indexed | 2024-04-13T16:44:17Z |
| format | Article |
| id | doaj.art-fdcfdddd98a84ae0b940bfefbb695ce9 |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-04-13T16:44:17Z |
| publishDate | 2017-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-fdcfdddd98a84ae0b940bfefbb695ce92022-12-22T02:39:08ZengDove Medical PressInternational Journal of COPD1178-20052017-08-01Volume 122291230534094When is dual bronchodilation indicated in COPD?Thomas MHalpin DMGMiravitlles MMike Thomas,1 David MG Halpin,2 Marc Miravitlles3 1Primary Care and Population Sciences, University of Southampton, Southampton, 2Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK; 3Pneumology Department, Hospital Universitari Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain Abstract: Inhaled bronchodilator medications are central to the management of COPD and are frequently given on a regular basis to prevent or reduce symptoms. While short-acting bronchodilators are a treatment option for people with relatively few COPD symptoms and at low risk of exacerbations, for the majority of patients with significant breathlessness at the time of diagnosis, long-acting bronchodilators may be required. Dual bronchodilation with a long-acting β2-agonist and long-acting muscarinic antagonist may be more effective treatment for some of these patients, with the aim of improving symptoms. This combination may also reduce the rate of exacerbations compared with a bronchodilator-inhaled corticosteroid combination in those with a history of exacerbations. However, there is currently a lack of guidance on clinical indicators suggesting which patients should step up from mono- to dual bronchodilation. In this article, we discuss a number of clinical indicators that could prompt a patient and physician to consider treatment escalation, while being mindful of the need to avoid unnecessary polypharmacy. These indicators include insufficient symptomatic response, a sustained increased requirement for rescue medication, suboptimal 24-hour symptom control, deteriorating symptoms, the occurrence of exacerbations, COPD-related hospitalization, and reductions in lung function. Future research is required to provide a better understanding of the optimal timing and benefits of treatment escalation and to identify the appropriate tools to inform this decision. Keywords: COPD, dual bronchodilation, monobronchodilation, ICS, triple therapyhttps://www.dovepress.com/when-is-dual-bronchodilation-indicated-in-copd-peer-reviewed-article-COPDCOPDdual bronchodilationmono bronchodilationICStriple therapy |
| spellingShingle | Thomas M Halpin DMG Miravitlles M When is dual bronchodilation indicated in COPD? International Journal of COPD COPD dual bronchodilation mono bronchodilation ICS triple therapy |
| title | When is dual bronchodilation indicated in COPD? |
| title_full | When is dual bronchodilation indicated in COPD? |
| title_fullStr | When is dual bronchodilation indicated in COPD? |
| title_full_unstemmed | When is dual bronchodilation indicated in COPD? |
| title_short | When is dual bronchodilation indicated in COPD? |
| title_sort | when is dual bronchodilation indicated in copd |
| topic | COPD dual bronchodilation mono bronchodilation ICS triple therapy |
| url | https://www.dovepress.com/when-is-dual-bronchodilation-indicated-in-copd-peer-reviewed-article-COPD |
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