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Inhaled Combination Therapy With Long-Acting β2-Agonists and Corticosteroids in Stable COPD*

Mario Cazzola, MD, FCCP; Ronald Dahl, MD
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*From the Department of Respiratory Medicine (Dr. Cazzola), Unit of Pneumology and Allergology, Antonio Cardarelli Hospital, Naples, Italy; and the Department of Respiratory Diseases (Dr. Dahl), University Hospital Aarhus, Aarhus, Denmark.

Correspondence to: Mario Cazzola, MD, FCCP, Via del Parco Margherita 24, 80121 Napoli, Italy; e-mail mcazzola@qubisoft.it



Chest. 2004;126(1):220-237. doi:10.1378/chest.126.1.220
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Long-acting β2-agonists (LABAs) have been shown to be effective first-line bronchodilators in the treatment of COPD patients, and inhaled corticosteroids (ICSs) have been shown to reduce the frequency and/or severity of exacerbations in COPD patients. The concomitant use of a LABA and an ICS can influence both airway obstruction (ie, smooth muscle contraction, increased cholinergic tone, and loss of elastic recoil), and airway inflammation (ie, increased numbers of neutrophils, macrophages, and CD8+ lymphocytes, elevated interleukin-8 and tumor necrosis factor-α levels, and protease/antiprotease imbalance). They are also able to reduce the total number of bacteria adhering to the respiratory mucosa in a concentration-dependent manner without altering the bacterial tropism for mucosa, and to preserve ciliated cells. Several clinical trials support the concept of inhaled combination therapy with LABAs and corticosteroids in stable COPD patients. This type of therapy not only improves airflow obstruction but also provides clinical benefits, as manifested by sustained reduction in overall symptoms, improvements in health-related quality of life, and reductions in exacerbations. All of these effects are very important because, despite recent advances in our understanding of COPD and its treatment, therapy remains suboptimal for a considerable number of patients.

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