Affiliation:
1. Pirogov Russian National Research Medical University
Abstract
Inhaled bronchodilators are the basis of pharmacological therapy of chronic obstructive pulmonary disease. Bronchodilation can be reached in two different ways: by stimulation of β2 -adrenoreceptors and inhibition of M3-cholinoreceptors. Combined long acting bronchodilators show additional effect on lung function and clinical outcomes of the disease. This article covers the issues of efficacy and safety of different combined bronchodilators. Chronic obstructive pulmonary disease (COPD) is a disease characterized by the limitation of air flow velocity, which is reversible incompletely. The restriction of air flow velocity is usually progressive and is associated with inflammatory response of the lungs to pathogenic particles or gases, with tobacco smoking being the main cause. COPD leads to a number of significant systemic effects that can worsen the course of the disease. It is important that COPD can be prevented and treated. The Global Strategy for the Diagnosis, Treatment and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) considers long-acting inhaled bronchodilators as the basis for long-term maintenance therapy of chronic obstructive pulmonary disease. GOLD recommends the use of both long-acting anticholinergic drugs (LAMA) and long-acting β2-agonists (LABA) in all categories of patients, including as the first line in people with severe symptoms and low risk of exacerbations. bronchodilators reduce the severity of shortness of breath and other symptoms of the disease, and also increase exercise tolerance. The individual components have different application points: LAMA inhibit the effect of acetylcholine mainly on M1- and M3-muscarinic receptors, LABA stimulate β2-adrenergic receptors, increasing the content of intracellular cAMP and causing bronchodilation. Both classes of drugs potentiate each other’s activity, increasing the relaxing effect on the smooth muscles of the bronchi.