Avances en la terapia inhalatoria de las vías aéreas en asma y EPOC

Abstract

The inhalers are the most efficient and safest form of treatment in stable bronchial obstructive disease: Asthma and COPD. There are two types of inhalers: a) dose metered inhalers (MDI) for the administration of bronchodilator drugs (?2 agonists and anti-cholinergics) and corticosteroids dissolved in a HFA propellent, and b) dry powder inhalers (DPI) that are activated by the inspiratory flow of the patient, without need of an aero-chamber. The clinical prescription of inhaled bronchodilators and corticosteroids will depend on their pharmacological activity, dosing, long of action and the possibility of association with other drugs that empower the therapeutic result. The short acting ?2 agonists (SABA) last 4 hours, while the long acting ones (LABA) extend their effect to 12-24 hours. In persistent asthma the combination of an inhaled corticosteroid with a long acting ?2 agonist will control 95% of patients. A new combination of mometasone with formoterol will help in this endeavour. Anti-cholinergic medication dilate the airways by a different mechanism, and are short (SAMA) and long lasting (LAMA) Ipratropium is a short action anti cholinergic drug and therapeutically is limited to mild COPD (Gold A). The long action anti cholinergic, as tiotropium and glicopirronium, works for 24 hours and are useful in moderate to severe COPD (Gold B and C), either alone or associated to a 24 hours acting ?2 agonist (LABA). Another option in this category of COPD is the combination of an inhaled corticosteroid inhaler (CEI) with a LABA, taking into account that could increase the occurrence of pneumonia or reactivation of tuberculosis. In the more severe COPD patients (Gold D) the actual tendency is the use of a triple association: LAMA (tiotropium or glicopirronium) + a 24 hours LABA + CEI. The association of glicopirronium with indacaterol has been shown to be as useful as the triple associated therapy.