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| Key
Learning Points |
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- Combining
an ICS with a LABA is supported by a good scientific
rationale more in asthma than in COPD.
- Biological effects of glucocorticosteroids are variously mediated in cells:
- Direct
genomic pathway/trans-activation process;
- Indirect
genomic pathway/trans-repression;
- Non-genomic
pathway.
- Corticosteroids are the mainstay of therapy in asthma, since they interfere with the pathophysiological activity of all the cells
and mediators involved in the chronic inflammation underlying asthma disease.
On the contrary, in COPD they minimally affect the inflammatory component
of the pathology and they are currently used only in association to
a bronchodilator in late stages of the disease.
- The pharmacological activity of β2-agonists is due to their interaction with specific
receptors (β2-adrenergic receptors), widely
distributed in the lungs.
Their activation determines airway smooth muscle
relaxation (bronchodilation)
and important additional non-bronchodilator effects.
- Whereas bronchodilators, including β2-agonists, represent the cornerstone in COPD therapy, in asthma they are used only in
association with corticosteroids in moderate-to-severe persistent
asthma.
- The combined administration of a LABA and an ICS has been proved to be clearly efficacious sometimes in asthma and COPD: the final improved
clinical effect is due to the mutual interaction of the two classes
at pathophysiological (particularly in asthma) and molecular levels (asthma
and COPD).
- Several studies have widely demonstrated the clinical benefits of combining a LABA and an ICS, more in asthma than in COPD.
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