Is it preferable to administer a bronchodilator once- or twice-daily when treating COPD? - 20/11/23

Abstract |
Nocturnal and early morning symptoms are common and uncomfortable in many patients with COPD, and are likely to affect their long-term outcomes. However, it is still debated whether it is better to give long-acting bronchodilators once- or twice-daily to symptomatic COPD patients. The functional link between circadian rhythms of autonomic tone and airway calibre explains why the timing of administration of bronchodilators in chronic airway diseases can induce different effects when taken at different biological (circadian) times. However, the timing also depends on the pharmacological characteristics of the bronchodilator to be used. Because the profile of bronchodilation produced by once-daily vs. twice-daily long-acting bronchodilators differs throughout 24 h, selecting long-acting bronchodilators may be customized to specific patient preferences based on the need for further bronchodilation in the evening. This is especially helpful for people who experience respiratory symptoms at night or early morning. Compared to placebo, evening bronchodilator administration is consistently linked with persistent overnight improvements in dynamic respiratory mechanics and inspiratory neural drive. The current evidence indicates that nocturnal and early morning symptoms control is best handled by a LAMA taken in the evening. In contrast, it seems preferable to use a LABA for daytime symptoms. Therefore, it can be speculated that combining a LAMA with a LABA can improve bronchodilation and control symptoms better. Both LAMA and LABA must be rapid in their onset of action. Aclidinium/formoterol, a twice-daily combination, is the most studies of the available LAMA/LABA combinations in terms of impact on daytime and nocturnal symptoms.
Le texte complet de cet article est disponible en PDF.Highlights |
• | An important question when treating a patient suffering from COPD is whether it is better to use a bronchodilator on a once- or twice-daily basis. |
• | There is an increasing focus on controlling nocturnal and early morning symptoms, which are the most troublesome for people with COPD. |
• | The twice-daily dosing of bronchodilators should be considered as a useful approach at least for the symptomatic treatment of COPD. |
• | Due to a lack of adequate large studies, we are still unable to establish whether twice-daily administration of bronchodilators may be preferable to the once-daily dose. |
• | The currently available information suggests that a LAMA/LABA combination administered twice-daily may induce consistent improvements in early-morning and night-time symptoms. |
Keywords : COPD, LABAs, LAMAs, Symptom variability, Once-daily, Twice-daily
Plan
Vol 219
Article 107439- novembre 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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