Modern possibilities of bronchodilation therapy for patients with chronic obstructive pulmonary disease

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Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The socioeconomic burden of COPD is significant and requires targeted resources to optimize COPD management, including symptom control, exacerbation prevention, and effective treatment of comorbidities. Long-acting inhaled bronchodilators have been the mainstay of pharmacological therapy for COPD for many years at any severity of the disease. Numerous randomized controlled trials (RCTs) indicate early and sustained benefits against the background of therapy with a combination of long-acting inhaled bronchodilators in relation to both clinical and functional indicators and quality of life parameters, the frequency of exacerbations. An integrated research program to evaluate the effectiveness of the combination of long-acting bronchodilators, represented by indacaterol/glycopyrronium (IND/GLY), showed a significant advantage in the effect on the clinical and functional characteristics of COPD compared to monotherapy with indacaterol, glycopyrronium, tiotropium, as well as combinations of tiotropium and formoterol, salmeterol/fluticasone. Thus, clinical trial data demonstrate a higher effectiveness of IND/GLY in relation to lung function, COPD symptoms and a reduction in the frequency of exacerbations. Available evidence suggests that the most common comorbidity in patients with COPD is cardiovascular diseases (CVDs), reflecting a multicomponent and complex pathophysiological cardiorespiratory continuum. In addition, CVDs remain one of the main causes of mortality in patients with COPD. Evaluation of the effect of IND/GLY on cardiac function in patients with COPD showed a significant reduction in the level of pulmonary hyperinflation (PHI), which led to improved cardiac function. A decrease in residual lung volume by 750 ml (p<0.0001) during IND/GLY therapy was accompanied by improved regional ventilation in COPD patients with pulmonary hypertension, a significant improvement in pulmonary microcirculation, and an increase in right and left ventricular end-diastolic volumes (p≤0.0002) and improvement in cardiac output (p=0.0034). The obtained evidence of achievement of the main clinical targets in the treatment of COPD and a safety profile comparable to placebo allows to consider IND/GLY as a drug for optimal initial and maintenance therapy of COPD in the majority of patients with severe symptoms, exacerbations of the disease and cardiovascular comorbidity.

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About the authors

Irina N. Trofimenko

Irkutsk State Medical Academy of Postgraduate Education, Department of Clinical Allergology and Pulmonology

Author for correspondence.
Email: tin11@mail.ru
ORCID iD: 0000-0003-2742-3794
SPIN-code: 9345-4572

Dr. Sci. (Med.), Associate Professor, Head of the Department of Clinical Allergology and Pulmonology

Russian Federation, Irkutsk

B. A. Chernyak

Irkutsk State Medical Academy of Postgraduate Education, Department of Clinical Allergology and Pulmonology

Email: tin11@mail.ru
ORCID iD: 0000-0002-5902-6198
SPIN-code: 5928-2586
Russian Federation, Irkutsk

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