When is dual bronchodilation indicated in COPD?

2.50
Hdl Handle:
http://hdl.handle.net/11287/620464
Title:
When is dual bronchodilation indicated in COPD?
Authors:
Thomas, M.; Halpin, David M; Miravitlles, M.
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.
Citation:
When is dual bronchodilation indicated in COPD? 2017, 12:2291-2305 Int J Chron Obstruct Pulmon Dis
Publisher:
Dove Press
Journal:
International journal of chronic obstructive pulmonary disease
Issue Date:
Aug-2017
URI:
http://hdl.handle.net/11287/620464
DOI:
10.2147/COPD.S138554
PubMed ID:
28814857
Additional Links:
https://dx.doi.org/10.2147/COPD.S138554
Note:
This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site.
Type:
Journal Article
Language:
en
ISSN:
1178-2005
Appears in Collections:
Respiratory Medicine; 2017 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorThomas, M.en
dc.contributor.authorHalpin, David Men
dc.contributor.authorMiravitlles, M.en
dc.date.accessioned2017-10-19T11:08:44Z-
dc.date.available2017-10-19T11:08:44Z-
dc.date.issued2017-08-
dc.identifier.citationWhen is dual bronchodilation indicated in COPD? 2017, 12:2291-2305 Int J Chron Obstruct Pulmon Disen
dc.identifier.issn1178-2005-
dc.identifier.pmid28814857-
dc.identifier.doi10.2147/COPD.S138554-
dc.identifier.urihttp://hdl.handle.net/11287/620464-
dc.description.abstractInhaled 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.en
dc.language.isoenen
dc.publisherDove Pressen
dc.relation.urlhttps://dx.doi.org/10.2147/COPD.S138554en
dc.rightsArchived with thanks to International journal of chronic obstructive pulmonary disease. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).en
dc.subjectWessex Classification Subject Headings::Respiratory medicineen
dc.titleWhen is dual bronchodilation indicated in COPD?en
dc.typeJournal Articleen
dc.identifier.journalInternational journal of chronic obstructive pulmonary diseaseen
dc.description.noteThis article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site.en
dc.type.versionPublisheden
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