Symptom variability and control in COPD: Advantages of dual bronchodilation therapy.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder characterized by usually progressive development of airflow obstruction that is not fully reversible. While most patients will experience symptoms throughout the day or in the morning upon awakening, many patients do not experience their symptoms as constant but report variability in symptoms during the course of the day or over time. Symptom variability adversely affects patients' health status and increases the risk of COPD exacerbations.



We examined data from the literature on symptom variability and control in patients with COPD, with focus on the use of inhaled bronchodilator therapy with long-acting muscarinic antagonist agents (LAMA) plus long-acting β2-agonists (LABA); in particular twice-daily fixed-dose combination LAMA/LABA therapy with aclidinium/formoterol.



Correct diagnosis and assessment of COPD requires comprehensive clinical and functional evaluation and consideration of individual needs to support the clinical decisions necessary for effective long-term management. Combining bronchodilators from different and complementary pharmacological classes with distinct mechanisms of action can increase the magnitude of bronchodilation as opposed to increasing the dose of a single bronchodilator.



The use of inhaled bronchodilator therapy with LAMA/LABA fixed-dose combinations in patients with stable COPD is supported by current evidence. This treatment approach provides robust effects on lung function and symptom control and may improve patients' adherence to treatment. Administration of the long-acting bronchodilators aclidinium and formoterol as twice daily fixed-dose aclidinium/formoterol 400/12 μg has the potential to control symptoms throughout the 24 h in patients with stable moderate-to-severe COPD.
Respiratory Unit, Ospedale San Paolo, Department of Health Science, Università degli Studi di Milano, Via Antonio di Rudinì 8, 20142 Milan, Italy.
Fabiano
F
Di Marco
Università degli Studi di Milano, Department of Biomedical and Clinical Sciences, Division of Respiratory Diseases "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, Via G.B. Grassi 74, 20157 Milan, Italy.
Pierachille
P
Santus
DIBIMIS, University of Palermo, via Trabucco 180, 90146 Palermo, Italy.
Nicola
N
Scichilone
AOU Città della Salute e della Scienza di Torino, University of Turin, Molinette Hospital, Lung Diseases Unit, via Genova 3, 10126 Turin, Italy.
Paolo
P
Solidoro
Section of Respiratory Diseases, Department of Medical Sciences, University of Ferrara, Via Ludovico Ariosto 35, 44121 Ferrara, Italy.
Marco
M
Contoli
Respiratory and Allergy Diseases Clinic, Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, L.go R Benzi 10, 16166 Genoa, Italy.
Fulvio
F
Braido
Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine and Therapeutics, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy. Electronic address: corsico@unipv.it.
Angelo Guido
AG
Corsico
D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000494:pharmacology*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination / Q000379:methods*; D005541:Forced Expiratory Volume / Q000187:drug effects; D000068759:Formoterol Fumarate / Q000008:administration & dosage / Q000494:pharmacology*; D006304:Health Status; D006801:Humans; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D016896:Treatment Outcome; D014326:Tropanes / Q000008:administration & dosage / Q000494:pharmacology*; D014797:Vital Capacity / Q000187:drug effects
D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D014326:Tropanes; C542859:aclidinium bromide; D000068759:Formoterol Fumarate
Aclidinium; Chronic obstructive pulmonary disease; Dual bronchodilator therapy; Formoterol; Lung function; Symptom variability