title: Effects of aclidinium on determinants of COPD severity: symptoms and quality of life.
abstract: The pathophysiology of chronic obstructive pulmonary disease (COPD) includes persistent airflow limitation, altered gas exchange, and enhanced chronic inflammatory response. According to disease severity in individual patients, exacerbations and comorbidities frequently occur. The overall nocturnal and daily symptoms have a strong impact on patient quality of life and clinical outcomes. Bronchodilators, by targeting two important aspects of COPD pathophysiology, ie, bronchoconstriction and lung hyperinflation, are the mainstay of therapy for COPD. Aclidinium bromide in particular is an anticholinergic molecule, approved for maintenance bronchodilator treatment of stable COPD, that combines high antimuscarinic activity with strong kinetic selectivity for the M3 receptor subtype. Moreover, the elevated plasma clearance of aclidinium has been related to low systemic bioavailability and low incidence of anticholinergic adverse events, whereas the reduced residence time at M2 receptors provides good cardiovascular safety. Altogether, these characteristics result in a high safety and tolerability profile. This review aims to reappraise the contribution of symptoms and of the level of quality of life determinants on COPD severity and to evaluate how therapeutic strategies with aclidinium may positively impact on these specific determinants of disease severity.
authors.affiliation: Research Centre on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Contoli
authors.affiliation: Cardiovascular and Thoracic Department, Città della Salute, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Solidoro
authors.affiliation: Department of Health Sciences, University of Milan, Milan, Italy; Respiratory Unit, San Paolo Hospital, Milan, Italy.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Di Marco
authors.affiliation: Department of Internal Medicine, Section of Pulmonology (DIBIMIS), University of Palermo, Palermo, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Scichilone
authors.affiliation: Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Corsico
authors.affiliation: Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Braido
authors.affiliation: Respiratory Unit, San Paolo Hospital, Milan, Italy; Pulmonary Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan-IRCCS, Milan, Italy.
authors.forename: Pierachille
authors.initials: P
authors.lastname: Santus
mesh_terms: D016084:Bronchoconstriction / Q000187:drug effects; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014326:Tropanes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D014326:Tropanes; C542859:aclidinium bromide
keywords: COPD; LAMA; aclidinium; daily symptoms; quality of life