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Future concepts in bronchodilation for COPD: dual- versus monotherapy
European Respiratory Review ( IF 7.5 ) Pub Date : 2021-06-01 , DOI: 10.1183/16000617.0023-2021
Dave Singh 1 , James F Donohue 2 , Isabelle H Boucot 3 , Neil C Barnes 4, 5 , Chris Compton 4 , Fernando J Martinez 5
Affiliation  

Most patients with COPD are recommended to initiate maintenance therapy with a single long-acting bronchodilator, such as a long-acting muscarinic antagonist or long-acting β2-agonist. However, many patients receiving mono-bronchodilation continue to experience high symptom burden, suggesting that patients are frequently not receiving optimal treatment. Treatment goals for COPD are often broad and not individually tailored, making initial treatment response assessments difficult. A personalised approach to initial maintenance therapy, based upon an individual's symptom burden and exacerbation risk, may be more appropriate.

An alternative approach would be to maximise bronchodilation early in the disease course of all patients with COPD. Evidence suggests that dual bronchodilation has greater and consistent efficacy for lung function and symptoms than mono-bronchodilation, whilst potentially reducing the risk of exacerbations and disease deterioration, with a similar safety profile to mono-bronchodilators. Improvements in lung function and symptoms between dual- and mono-bronchodilation have also been demonstrated in maintenance-naïve patients, who are most likely to resemble those at first presentation in a clinical setting. Despite promising results, there are several evidence gaps that need to be addressed to allow decision makers to evaluate the merits of a widespread earlier introduction of dual bronchodilation.



中文翻译:

COPD 支气管扩张的未来概念:双重疗法与单一疗法

大多数 COPD 患者被推荐使用单一的长效支气管扩张剂开始维持治疗,例如长效毒蕈碱拮抗剂或长效 β2激动剂。然而,许多接受单支气管扩张的患者继续经历高症状负担,这表明患者经常没有接受最佳治疗。COPD 的治疗目标通常很宽泛,而且不是针对个体量身定制的,这使得初始治疗反应评估变得困难。基于个体症状负担和恶化风险的个性化初始维持治疗方法可能更合适。

另一种方法是在所有 COPD 患者的病程早期最大限度地扩张支气管。有证据表明,与单支气管扩张剂相比,双支气管扩张剂对肺功能和症状具有更大且一致的疗效,同时可能降低恶化和疾病恶化的风险,其安全性与单支气管扩张剂相似。双支气管扩张和单支气管扩张之间的肺功能和症状改善也已在未经维持治疗的患者中得到证实,这些患者最有可能与临床环境中首次出现的患者相似。尽管取得了令人鼓舞的结果,但仍有一些证据缺口需要解决,以便决策者能够评估早期广泛引入双重支气管扩张的优点。

更新日期:2021-06-24
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