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Multidisciplinary Respiratory Medicine

, 9:50

First Online: 15 October 2014Received: 14 July 2014Accepted: 26 September 2014


The most recent guidelines define COPD in a multidimensional way, nevertheless the diagnosis is still linked to the limitation of airflow, usually measured by the reduction in the FEV1-FVC ratio below 70%. However, the severity of obstruction is not directly correlated to symptoms or to invalidity determined by COPD. Thus, besides respiratory function, COPD should be evaluated based on symptoms, frequency and severity of exacerbations, patient’s functional status and health related quality of life HRQoL. Therapy is mainly aimed at increasing exercise tolerance and reducing dyspnea, with improvement of daily activities and HRQoL. This can be accomplished by a drug-induced reduction of pulmonary hyperinflation and exacerbations frequency and severity. All guidelines recommend bronchodilators as baseline therapy for all stages of COPD, and long-acting inhaled bronchodilators, both beta-2 agonist LABA and antimuscarinic LAMA drugs, are the most effective in regular treatment in the clinically stable phase. The effectiveness of bronchodilators should be evaluated in terms of functional relief of bronchial obstruction and pulmonary hyperinflation, symptomatic exercise tolerance and HRQoL, and clinical improvement reduction in number or severity of exacerbations, while the absence of a spirometric response is not a reason for interrupting treatment, if there is subjective improvement in symptoms. Because LABA and LAMA act via different mechanisms of action, when administered in combination they can exert additional effects, thus optimizing i.e. maximizing sustained bronchodilation in COPD patients with severe airflow limitation, who cannot benefit or can get only partial benefit by therapy with a single bronchodilator. Recently, a fixed combination of ultra LABA-LAMA indacaterol-glycopyrronium has shown that it is possible to get a stable and persistent bronchodilation, which can help in avoiding undesirable fluctuations of bronchial calibre.

KeywordsBronchodilation COPD Dyspnea Exercise tolerance Fixed combination indacaterol-glycopyrronium HRQoL Hyperinflation LABA LAMA Electronic supplementary materialThe online version of this article doi:10.1186-2049-6958-9-50 contains supplementary material, which is available to authorized users.

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Author: Stefano Nardini - Gianna Camiciottoli - Salvatore Locicero - Rosario Maselli - Franco Pasqua - Giovanni Passalacqua - Riccar


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