Pharmacological basis and scientific rationale underlying the targeted use of inhaled corticosteroid/long-acting β₂-adrenergic agonist combinations in chronic obstructive pulmonary disease treatment

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is a complex respiratory disorder, whose medical and socioeconomic burden as one of the main causes of morbidity and mortality is increasing worldwide. COPD pathophysiology includes chronic airway/lung inflammation and progressive airflow limitation. Therefore, anti-inflammatory and bronchodilator agents are key players in COPD treatment.

Areas covered: This review article discusses the complementary molecular interactions connecting the respective mechanisms of action of inhaled corticosteroids (ICS) and long-acting β₂-adrenergic agonists (LABAs). Moreover, attention is also focused on clinical trials, which have shown that ICS/LABA combinations are very effective in improving COPD symptoms and lung function, being also able to significantly reduce disease exacerbations.

Expert opinion: In selected subgroups of COPD patients, ICS/LABA combinations represent a very useful therapeutic approach for this widespread chronic respiratory disease. In addition to the well-known fixed-dose drug associations such as fluticasone propionate/salmeterol xinafoate and budesonide/formoterol fumarate, other newly developed ICS/LABA combinations are currently emerging as very interesting pharmacological options for COPD treatment.

Keywords:

• clinical trials
• chronic obstructive pulmonary disease
• inhaled corticosteroids
• long-acting β₂-adrenergic agonists
• molecular interactions

Declaration of interest

G Pelaia received lecture fees and consultancy fees from Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi, Dompè, GlaxoSmithKline, Guidotti-Malesci, Mundipharma and Novartis. CC Muzzio is a GlaxoSmithKline employee. A Vatrella received lecture fees and consultancy fees from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Dompè, GlaxoSmithKline, Guidotti-Malesci, Mundipharma and Novartis. R Maselli received lecture fees and consultancy fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Guidotti-Malesci, Mundipharma and Novartis. MS Magnoni is a GlaxoSmithKline employee. A Rizzi is a GlaxoSmithKline employee. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Notes

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