Features and significance of the early bronchodilatation effect of the first dose of a long-acting bronchodilator alone and in fixed combination in the treatment of chronic obstructive pulmonary disease
- Authors: Sharova N.V.1, Cherkashin D.V.1, Grishayev S.L.1, Efimov S.V.1, Kharitonov M.A.1, Turdialieva S.A.1
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Affiliations:
- Military medical academy of S.M. Kirov
- Issue: Vol 24, No 1 (2022)
- Pages: 25-34
- Section: Research paper
- URL: https://journals.rcsi.science/1682-7392/article/view/88616
- DOI: https://doi.org/10.17816/brmma88616
- ID: 88616
Cite item
Abstract
The early bronchodilatory effects of the first dose of long-acting anticholinergics (glycopyrronium and tiotropium) were compared with those of a fixed double combination of long-acting bronchodilators of various classes (indacaterol/glycopyrronium) in patients with stable chronic obstructive pulmonary disease. The possibility of using the results of an early bronchodilatory response to predict their effectiveness in the basic therapy of chronic obstructive pulmonary disease is evaluated. A total of 176 patients with chronic obstructive pulmonary disease were examined. The patients were randomized into three groups. The first group (n = 66) took glycopyrronium, the second group (n = 60) received a combination of indacaterol/glycopyrronium, and the third group (n = 50, control) took tiotropium. Broncholytic tests with the listed drugs were evaluated. The early bronchodilatory effect of the first dose of 110/50 mcg indacaterol/glycopyrronium was manifested by significant bronchodilation (p < 0.001) from 30 min, reached its maximum value 60 min after drug intake, and persisted after a 28-day course of treatment. The combination of indacaterol/glycopyrronium provided rapid and prolonged bronchodilation in patients with stable chronic obstructive pulmonary disease, demonstrating advantages over the isolated use of glycopyrronium and tiotropium. Maximization of bronchodilation by the sequential use of glycopyrronium and salbutamol leads to an increase in the volume of forced exhalation in the first second on the 90th min, comparable with the results of indacaterol/glycopyrronium on the 60th min after drug intake, which indicates the clinical feasibility of maximizing bronchodilation with drugs both separately and in combination. Based on a direct positive correlation between the initial value of the forced expiratory volume in the first second and the value on day 28 of indacaterol/glycopyrronium therapy, an equation for predicting the individual effectiveness of the drug during treatment is derived.
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##article.viewOnOriginalSite##About the authors
Natalia V. Sharova
Military medical academy of S.M. Kirov
Author for correspondence.
Email: natali.sharowa2014@yandex.ru
ORCID iD: 0000-0002-0120-0632
SPIN-code: 5591-9782
candidate of medical sciences, assistant professor
Russian Federation, Saint PetersburgDmitriy V. Cherkashin
Military medical academy of S.M. Kirov
Email: cherkashin_dmitr@mail.ru
ORCID iD: 0000-0003-1363-6860
SPIN-code: 2781-9507
doctor of medical sciences, professor
Russian Federation, Saint PetersburgSergey L. Grishayev
Military medical academy of S.M. Kirov
Email: grishaev_med@mail.ru
ORCID iD: 0000-0002-4830-5220
SPIN-code: 3854-1566
doctor of medical sciences, professor
Russian Federation, Saint PetersburgSemen V. Efimov
Military medical academy of S.M. Kirov
Email: sve03helper@rambler.ru
ORCID iD: 0000-0002-0384-3359
candidate of medical sciences
Russian Federation, Saint PetersburgMikhail A. Kharitonov
Military medical academy of S.M. Kirov
Email: micjul11@yandex.ru
ORCID iD: 0000-0002-6521-7986
SPIN-code: 7678-2278
doctor of medical sciences, professor
Russian Federation, Saint PetersburgSayera A. Turdialieva
Military medical academy of S.M. Kirov
Email: turdialieva@mail.ru
ORCID iD: 0000-0002-9481-8748
SPIN-code: 5970-8341
candidate of medical sciences, assistant professor
Russian Federation, Saint PetersburgReferences
- Salukhov VV, Kryukov EV, Kharitonov MA, et al. Triple therapy in a single inhaler for chronic obstructive pulmonary disease: clinical studies and case report (real practice). Medical Council. 2021;(16):174–184. (In Russ.). doi: 10.21518/2079-701X-2021-16-174-184
- Kazantsev VA, Komarov GK, Mokhovikov GI, et al. Dual bronchodilation in therapy of stable chronic obstructive pulmonary disease. Bulletin of the Russian Мilitary Мedical Аcademy. 2016;(4):228–234. (In Russ.).
- Aisanov ZR, Avdeev SN, Arkhipov VV, et al. National clinical guidelines on diagnosis and treatment of chronic obstructive pulmonary disease: a clinical decision-making algorithm. Russian Pulmonology. 2017;27(1):13–20. (In Russ.). doi: 10.18093/0869-0189-2017-27-1-13-2
- Avdeev SN, Trushenko NV. New opportunities of dual bronchodilation therapy for patients with chronic obstructive pulmonary disease. Therapeutic Аrchive. 2019;91(3):76–85. (In Russ.). doi: 10.26442/00403660.2019.03.000136
- Cazzola M, Rogliani PJ. Comparative effectiveness of indacaterol/glycopyrronium in the treatment of chronic obstructive pulmonary disease. Comp Eff Res. 2017;6(7):627–636. doi: 10.2217/cer-2017-0037
- Christer J, Andrei M, Andre FS, et al. Bronchodilator reversibility in asthma and COPD: findings from three large population studies. Eur Respir J. 2019;54(3):45–36. doi: 10.1183/13993003.00561-2019
- Oba Y, Keeney E, Ghatehorde N, Dias S. Dual combination therapy versus long-acting bronchodilators alone for chronic obstructive pulmonary disease (COPD): a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2018;12:CD012620. doi: 10.1002/14651858.CD01262
- Mastrodicasa MA, Droege CA, Mulhall AM, et al Long acting muscarinic antagonists for the treatment of chronic obstructive pulmonary disease: a review of current and developing drugs. Expert Opin Investig Drugs. 2017;26(2):161–174. doi: 10.1080/13543784.2017.1276167
- Trofimov VI, Sorokina LN. Patogeneticheskie osnovy kholinoliticheskoi terapii i vozmozhnye mekhanizmy ee potentsirovaniya pod vliyaniem β2-adrenomimetikov. Russian Pulmonology. 2014;(2):91–98. (In Russ.). doi: 10.18093/0869-0189-2014-0-2-91-99
- Meurs H, Dekkers BG, Maarsingh Н, et al. Muscarinic receptors on airway mesenchymal cells: novel findings for an ancient target. Pulm Pharmacol Ther. 2013;26(1):145–155. doi: 10.1016/j.pupt. 2012.07.003
- Cazzola M, Molimard М. The scientific rationale for combining long-acting β2-agonists and muscarinic antagonists in COPD. Pulm Pharmacol Ther. 2010;23(4):257–267. doi: 10.1016/j.pupt.2010.03.003
- Meurs HA, Oenema TA, Kistemaker LEM, Gosens R. New perspective on muscarinic receptor antagonism in obstructive airway disease. Curr Opin Pharmacol. 2013;13(3):316–323. doi: 10.1016/j.coph.2013.04.004
- Kharitonov MA, Shustov SB, Kurenkova IG, Kitsyshin VP. Funktsiya vneshnego dykhaniya: teoriya i praktika. Saint Petersburg: Normedizdat; 2013. P. 114–117. (In Russ.).
- Aisanov ZR. Stereotipy v lechenii KhOBL i ikh puti ikh preodoleniya: uroki issledovaniya UPLIFT. Atmosfera. Pul'monologiya i allergologiya. 2009;(2):24–31. (In Russ.).
- Tashkin DP. Long acting anticholinergic use in chronic obstructive pulmonare disease effecacy and safety. Curr Opin Pulm Med. 2010;16:97–105. doi: 10.1097/MCP.0b013e328335df1e
- Singh D. New combination bronchodilators for chronic obstructive pulmonary disease: current evidence and future perspectives. Br J Clin Pharmacol. 2015;79(5):695–708. doi: 10.1111/bcp.12545
- Avdeev SN, Aisanov ZR. Maximal bronchodilation with starting therapy of chronic obstructive pulmonary disease: an influence on the course of the disease. Russian Pulmonology. 2016;26(5): 604–609. (In Russ.). doi: 10.18093/0869-0189-2016-26-5-604-609
- Quizon A, Colin AA, Pelosi U, Rossi GA. Treatment of disorders characterized by reversible airway obstruction in childhood: are anti-cholinergic agents the answer? Curr Pharm Des. 2012;18(21):3061–3085. doi: 10.2174/1381612811209023061
- O'Donnell DE, Milne KM, James MD. Dyspnea in COPD: New Mechanistic Insights and Management Implications. Adv Ther. 2020;37(1):41–60. doi: 10.1007/s12325-019-0