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European Respiratory Review : An... Sep 2014The burden of chronic obstructive pulmonary disease (COPD) is considerable, both socially and economically. Central to COPD management is the use of long-acting... (Review)
Review
The burden of chronic obstructive pulmonary disease (COPD) is considerable, both socially and economically. Central to COPD management is the use of long-acting bronchodilators, which provide patients with optimal bronchodilation and improvements in symptoms. The once-daily, long-acting β2-agonist indacaterol, the long-acting muscarinic antagonist glycopyrronium, and the indacaterol/glycopyrronium fixed-dose combination QVA149 have all been shown to significantly improve lung function and patient-reported outcomes. The ability to take medication appropriately is important. Easy to use, low resistance devices may help patients take their medication and achieve good drug deposition. There is a need to optimise COPD management by treating the right patients with the right therapy at the right time during the course of their disease. Herein, we present a view on the current COPD management landscape and current unmet needs, and look to the future of COPD treatment and how patient care can be optimised.
Topics: Asthma; Bronchodilator Agents; Diagnosis, Differential; Humans; Pulmonary Disease, Chronic Obstructive
PubMed: 25176969
DOI: 10.1183/09059180.00004014 -
American Family Physician Jul 2018
Review
Topics: Administration, Intranasal; Bronchiolitis; Bronchodilator Agents; Double-Blind Method; Humans; Nebulizers and Vaporizers; Saline Solution, Hypertonic
PubMed: 30215960
DOI: No ID Found -
American Family Physician Jan 2017
Review
Topics: Administration, Inhalation; Bronchodilator Agents; Cholinergic Antagonists; Humans; Pulmonary Disease, Chronic Obstructive; Quinuclidines; Treatment Outcome
PubMed: 28084712
DOI: No ID Found -
Respiratory Care Jun 2018
Topics: Asthma; Biological Therapy; Bronchodilator Agents; Glucocorticoids; Humans; Oxygen Inhalation Therapy; Pulmonary Disease, Chronic Obstructive
PubMed: 29794214
DOI: No ID Found -
Respiratory Care Sep 2020COPD and asthma have different risk factors and pathogenesis, but they share a pathophysiologic hallmark characterized by small airways disease. Although difficult to... (Review)
Review
COPD and asthma have different risk factors and pathogenesis, but they share a pathophysiologic hallmark characterized by small airways disease. Although difficult to explore and measure, modifications of distal airways' pathophysiology and biology represent an early sign of obstructive disease and should be researched and assessed in everyday clinical practice. In the last 15 years, computed microtomography scans have shed light on the anatomy and physiology of the so-called silent zone, and research devoted to investigate the effect of inhaled treatments on small airway pathophysiology has been increasing. This narrative review offers a historical summary of researchers and landmark studies that reported, defined, and advanced the research on small airways. We then discuss the latest findings on the role and characteristics of the small airways' inflammatory and cellular structure, and we describe the assessment tools available to detect small airways dysfunction in COPD and asthma and the effect of bronchodilators and inhaled steroids on functional and biological biomarkers. Finally, we analyze the newest technological therapeutic advances aimed at small airways treatment in terms of inhalation devices and small particle size molecules.
Topics: Asthma; Bronchodilator Agents; Humans; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests
PubMed: 32209703
DOI: 10.4187/respcare.07237 -
American Journal of Respiratory and... Aug 2023
Topics: Humans; Reference Values; Asthma; Bronchodilator Agents; Spirometry
PubMed: 37478330
DOI: 10.1164/rccm.202306-1082ED -
Advances in Respiratory Medicine Mar 2024, which has been published by MDPI since 2022, serves as a platform for hosting pneumological studies [...].
, which has been published by MDPI since 2022, serves as a platform for hosting pneumological studies [...].
Topics: Humans; Bronchodilator Agents; Asthma; Pulmonary Medicine; Dry Powder Inhalers; Administration, Inhalation; Respiratory Function Tests
PubMed: 38525776
DOI: 10.3390/arm92020017 -
Respiratory Care Sep 2017
Topics: Administration, Inhalation; Bronchodilator Agents; Humans; Lung Diseases, Obstructive
PubMed: 28830986
DOI: 10.4187/respcare.05786 -
NPJ Primary Care Respiratory Medicine Oct 2021Inhaled bronchodilators are central for the treatment of chronic obstructive pulmonary disease (COPD), as they can provide symptom relief and reduce the frequency and... (Review)
Review
Inhaled bronchodilators are central for the treatment of chronic obstructive pulmonary disease (COPD), as they can provide symptom relief and reduce the frequency and severity of exacerbations while improving health status and exercise tolerance. In 2017, glycopyrrolate (GLY) delivered via the eFlow® closed system (CS) nebulizer (nebulized GLY; 25 µg twice daily), was approved by the US Food and Drug Administration for maintenance treatment of moderate-to-very-severe COPD. This approval was based largely on results from the replicate, placebo-controlled, Phase III clinical trials- GOLDEN 3 and 4. In this review, we summarize key findings from secondary analyses of the GOLDEN 3 and 4 studies, and provide a comprehensive overview that may assist both pulmonologists and primary-care providers in their treatment decisions. Comorbidities are common among patients with COPD in clinical practice and may impact bronchodilator efficacy. This review highlights outcomes among subpopulations of patients with comorbidities (e.g., anxiety/depression, cardiovascular disease), and their impact on the efficacy of nebulized GLY. In addition, the efficacy and safety of nebulized GLY across various demographics (e.g., age, gender) and baseline disease characteristics (e.g., disease severity, rescue medication use) are discussed. Real-world outcomes with nebulized GLY, including device satisfaction, healthcare resource utilization, and exacerbations, are also presented. These secondary analyses and real-world data complement the primary results with nebulized GLY from Phase III studies and support the need for the inclusion of patients representative of real-world clinical practice in RCTs. In addition, these data suggest that RCTs for COPD therapies should be complemented with real-world observational studies.
Topics: Administration, Inhalation; Bronchodilator Agents; Glycopyrrolate; Humans; Muscarinic Antagonists; Pulmonary Disease, Chronic Obstructive; Treatment Outcome
PubMed: 34620878
DOI: 10.1038/s41533-021-00255-7 -
Role of combined indacaterol and glycopyrronium bromide (QVA149) for the treatment of COPD in Japan.International Journal of Chronic... 2015Once-daily dual-bronchodilator therapy with combined indacaterol and glycopyrronium bromide in one device (Ultibro, Breezhaler), often called QVA149, was first approved... (Meta-Analysis)
Meta-Analysis Review
Once-daily dual-bronchodilator therapy with combined indacaterol and glycopyrronium bromide in one device (Ultibro, Breezhaler), often called QVA149, was first approved in 2013 in Japan and Europe. As of November 2014, more than 40 countries had approved this medication except for the USA. This is the first dual bronchodilator in one device. Now, the Breezhaler is the only device that can provide long-acting muscarinic antagonist (glycopyrronium bromide), long-acting beta agonist (indacaterol), and a combination of the two medications (QVA149). The choice among the three medications allows a patient to use the same inhalation device even when the regimen is changed from single-bronchodilator therapy to dual-bronchodilator therapy. In addition, the quick bronchodilation effect and once-daily administration can improve patient adherence to medical treatment for chronic obstructive pulmonary disease (COPD). To our knowledge, as of November 2014, the safety and the efficacy of QVA149 have been evaluated in 14 randomized controlled trials. The 14 trials generally showed good safety profiles, and there were better or not-inferior bronchodilator effects of QVA149 when compared with placebo, or other inhaled medication. According to the Japanese Respiratory Society guidelines, QVA149 is a combination of the two first-line bronchodilators. Our meta-analysis indicated that QVA149 is superior to the salmeterol-fluticasone combination to treat COPD in respect of the frequency of adverse effects, exacerbation, pneumonia, and improvement of trough forced expiratory volume in 1 second (FEV1). Thus, we believe that QVA149 can be a key medication for COPD treatments.
Topics: Administration, Inhalation; Adrenergic beta-2 Receptor Agonists; Bronchodilator Agents; Drug Administration Schedule; Drug Combinations; Evidence-Based Medicine; Forced Expiratory Volume; Glycopyrrolate; Humans; Indans; Japan; Lung; Muscarinic Antagonists; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive; Quinolones; Randomized Controlled Trials as Topic; Time Factors; Treatment Outcome
PubMed: 25960646
DOI: 10.2147/COPD.S56067