Day and Night Control of COPD and Role of Pharmacotherapy: A Review.
COPD
ICS
LABA
adherence
circadian LAMA
dyspnea
follow-up
night
sleep
symptoms
Journal
International journal of chronic obstructive pulmonary disease
ISSN: 1178-2005
Titre abrégé: Int J Chron Obstruct Pulmon Dis
Pays: New Zealand
ID NLM: 101273481
Informations de publication
Date de publication:
2020
2020
Historique:
received:
26
11
2019
accepted:
03
05
2020
entrez:
2
7
2020
pubmed:
2
7
2020
medline:
29
6
2021
Statut:
epublish
Résumé
The topic of 24-hour management of COPD is related to day-to-night symptoms management, specific follow-up and patients' adherence to therapy. COPD symptoms strongly vary during day and night, being worse in the night and early morning. This variability is not always adequately considered in the trials. Night-time symptoms are predictive of higher mortality and more frequent exacerbations; therefore, they should be a target of therapy. During night-time, in COPD patients the supine position is responsible for a different thoracic physiology; moreover, during some sleep phases the vagal stimulation determines increased bronchial secretions, increased blood flow in the bronchial circulation (enhancing inflammation) and increased airway resistance (broncho-motor tone). Moreover, in COPD patients the circadian rhythm may be impaired. The role of pharmacotherapy in this regard is still poorly investigated. Symptoms can be grossly differentiated according to the different phenotypes of the disease: wheezing recalls asthma, while dyspnea is strongly related to emphysema (dynamic hyperinflation) or obstructive bronchiolitis (secretions). Those symptoms may be different targets of therapy. In this regard, GOLD recommendations for the first time introduced the concept of phenotype distinction suggesting the use of inhaled corticosteroids (ICS) particularly when an asthmatic pattern or eosiophilic inflammations are present, and hypothesized different approaches to target symptoms (ie, dyspnea) or exacerbations. Pharmacotherapy should be evaluated and possibly directed on the basis of circadian variations, for instance, supporting the use of twice-daily rapid-action bronchodilators and evening dose of ICS. Recommendations on day and night symptoms monitoring strategies and choice of the specific drug according to patient's profile are still not systematically investigated or established. This review is the summary of an advisory board on the topic "24-hour control of COPD and role of pharmacotherapy", held by five pulmonologists, experts in respiratory pathophysiology, pharmacology and sleep medicine.
Identifiants
pubmed: 32606638
doi: 10.2147/COPD.S240033
pii: 240033
pmc: PMC7283230
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Adrenergic beta-2 Receptor Agonists
0
Bronchodilator Agents
0
Muscarinic Antagonists
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1269-1285Informations de copyright
© 2020 Braghiroli et al.
Déclaration de conflit d'intérêts
The advisory board was sponsored by Chiesi Farmaceutici (Parma, Italy). Dr Alessio Piraino is an employee of Chiesi Farmaceutici S.p.A. Professor Pierachille Santus reports personal fees from GSK, Guidotti, Menarini International, ALK Abellò, and Berlin Chemie; grants, personal fees from AstraZeneca, Novartis, and Boehringer Ingelheim; grants from Chiesi Farmaceutici, during the conduct of the study. The authors report no other conflicts of interest in this work.
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