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Rationale and Clinical Use of Bronchodilators in Adults with Bronchiectasis

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Abstract

Currently, there is much controversy surrounding the therapeutic approach to pulmonary function abnormalities in patients with bronchiectasis and, consequently, whether and when to use bronchodilators in these patients. National and international guidelines on the treatment of bronchiectasis in adults do not recommend the routine use of bronchodilators because there is no evidence that a significant response to a bronchodilator or the presence or hyperresponsiveness of the airway are good predictors of future effective clinical response. However, some guidelines recommend them in the presence of airway obstruction and/or special conditions, which vary according to the guideline in question, although there are no recommendations on optimal dosing and bronchodilator treatment combined with or without inhaled corticosteroids. Nonetheless, in contrast with guideline recommendations, bronchodilators are overused in real-world patients with bronchiectasis even in the absence of airway obstruction, as demonstrated by analysis of national and international registries. This overuse can be explained by the awareness of the existence of a solid pharmacological rationale that supports the use of bronchodilators in the presence of chronic airway obstruction independent of its aetiology. We performed a systematic review of the literature and were able to verify that there are no randomised controlled trials (apart from a small study with methodological limitations and a very recent trial involving a not-very-large number of patients), or any long-term observational studies on the short- or long-term effect of bronchodilators in patients with bronchiectasis. Therefore, we believe that it is essential and even urgent to evaluate the effects of bronchodilators in these patients with appropriately designed studies.

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References

  1. Martínez-García MÁ, Agustí A. Heterogeneity and complexity in bronchiectasis: a pending challenge. Arch Bronconeumol (Engl Ed). 2019;55(4):187–8.

    Article  PubMed  Google Scholar 

  2. Aliberti S, Lonni S, Dore S, McDonnell MJ, Goeminne PC, Dimakou K, et al. Clinical phenotypes in adult patients with bronchiectasis. Eur Respir J. 2016;47(4):1113–22.

    Article  PubMed  Google Scholar 

  3. Perea L, Canto E, Suarez-Cuartin G, Aliberti S, Chalmers JD, Sibila O, et al. A cluster analysis of bronchiectasis patients based on the airway immune profile. Chest. 2021;159(5):1758–67.

    Article  CAS  PubMed  Google Scholar 

  4. Martínez-García MÁ, Vendrell M, Girón R, Máiz-Carro L, de la Rosa CD, de Gracia J, et al. The multiple faces of non-cystic fibrosis bronchiectasis. A cluster analysis approach. Ann Am Thorac Soc. 2016;13(9):1468–75.

    Article  PubMed  Google Scholar 

  5. Martínez-García MÁ, Olveira C, Máiz L, Girón RM, Prados C, de la Rosa D, et al. Bronchiectasis: a complex, heterogeneous disease. Arch Bronconeumol (Engl Ed). 2019;55(8):427–33.

    Article  PubMed  Google Scholar 

  6. Garcia-Olivé I, Marin A, Rodríguez-Pons L, Abad J. Trends in admission for bronchiectasis in a third-level hospital (2008–2017). Arch Bronconeumol (Engl Ed). 2019;55(4):217–8.

    Article  PubMed  Google Scholar 

  7. Mac Aogáin M, Narayana JK, Tiew PY, Ali NABM, Yong VFL, Jaggi TK, et al. Integrative microbiomics in bronchiectasis exacerbations. Nat Med. 2021;27(4):688–99.

    Article  PubMed  Google Scholar 

  8. Posadas T, Oscullo G, Zaldivar E, Villa C, Dobarganes Y, Girón R, et al. C-reactive protein concentration in steady-state bronchiectasis: prognostic value of future severe exacerbations. Data from the Spanish Registry of Bronchiectasis (RIBRON). Arch Bronconeumol (Engl Ed). 2021;57(1):21–7.

    Article  PubMed  Google Scholar 

  9. Chalmers JD, Aliberti S, Filonenko A, Shteinberg M, Goeminne PC, Hill AT, et al. Characterization of the “frequent exacerbator phenotype” in bronchiectasis. Am J Respir Crit Care Med. 2018;197(11):1410–20.

    Article  PubMed  Google Scholar 

  10. Chen CL, Huang Y, Yuan JJ, Li HM, Han XR, Martínez-García MÁ, et al. The roles of bacteria and viruses in bronchiectasis exacerbation: a prospective study. Arch Bronconeumol (Engl Ed). 2020;56(10):621–9.

    Article  CAS  PubMed  Google Scholar 

  11. Olveira C, Padilla A, Martínez-García MÁ, de la Rosa D, Girón RM, Vendrell M, et al. Etiology of bronchiectasis in a cohort of 2047 patients. An analysis of the Spanish Historical Bronchiectasis Registry. Arch Bronconeumol (Engl Ed). 2017;53(7):366–74.

    Article  Google Scholar 

  12. Lonni S, Chalmers JD, Goeminne PC, McDonnell MJ, Dimakou K, De Soyza A, et al. Etiology of non-cystic fibrosis bronchiectasis in adults and its correlation to disease severity. Ann Am Thorac Soc. 2015;12(12):1764–70.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Redondo M, Chalmers JD. Bronchiectasis guidelines-recommendations into practice. Arch Bronconeumol (Engl Ed). 2019;55(6):286–8.

    Article  PubMed  Google Scholar 

  14. Martinez-Garcia MÁ, de la Rosa D, Cantón R, Olveira C, Máiz-Carro L, Girón R, et al. Bronchiectasis: when the published scientific evidence proves insufficient. Arch Bronconeumol (Engl Ed). 2019;55(6):283–5.

    Article  PubMed  Google Scholar 

  15. Radovanovic D, Santus P, Blasi F, Sotgiu G, D’Arcangelo F, Simonetta E, et al. A comprehensive approach to lung function in bronchiectasis. Respir Med. 2018;145:120–9.

    Article  PubMed  Google Scholar 

  16. Luján M, Gallardo X, Amengual MJ, Bosque M, Mirapeix RM, Domingo C. Prevalence of bronchiectasis in asthma according to oral steroid requirement: influence of immunoglobulin levels. Biomed Res Int. 2013;2013:109219.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Martínez-García MÁ, Polverino E, Aksamit T. Bronchiectasis and chronic airway disease: it is not just about asthma and COPD. Chest. 2018;154(4):737–9.

    Article  PubMed  Google Scholar 

  18. Martínez-García MÁ, Posadas T, Sotgiu S, et al. Repeteability of circulating eosinophil measures and inhaled corticosteroids effect in bronchiectasis. A post hoc analysis of a randomized clinical trial. Arch Bronconeumol (Engl Ed). 2020;56(10):681–3.

    Article  PubMed  Google Scholar 

  19. Monsó E. Look at the wood and not at the tree: the microbiome in chronic obstructive lung disease and cystic fibrosis. Arch Bronconeumol (Engl Ed). 2020;56(1):5–6.

    Article  PubMed  Google Scholar 

  20. Boyton RJ, Altmann DM. Bronchiectasis: current concepts in pathogenesis, immunology, and microbiology. Annu Rev Pathol. 2016;11:523–54.

    Article  CAS  PubMed  Google Scholar 

  21. Fuschillo S, de Felice A, Balzano G. Mucosal inflammation in idiopathic bronchiectasis: cellular and molecular mechanisms. Eur Respir J. 2008;31(2):396–406.

    Article  CAS  PubMed  Google Scholar 

  22. Polverino E, Goeminne PC, McDonnell MJ, Aliberti S, Marshall SE, Loebinger MR, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50(3):1700629.

    Article  PubMed  Google Scholar 

  23. Hill AT, Sullivan AL, Chalmers JD, De Soyza A, Elborn JS, Floto RA, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax. 2019;74(Suppl 1):1–69.

    Article  PubMed  Google Scholar 

  24. Martínez-García MÁ, Máiz L, Olveira C, Girón RM, de la Rosa D, Blanco M, et al. Spanish guidelines on treatment of bronchiectasis in adults. Arch Bronconeumol (Engl Ed). 2018;54(2):88–98.

    Article  PubMed  Google Scholar 

  25. Chang AB, Bell SC, Torzillo PJ, King PT, Maguire GP, Byrnes CA, et al. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand. Thoracic Society of Australia and New Zealand guidelines. Med J Aust. 2015;202(1):130.

    Article  PubMed  Google Scholar 

  26. Al-Jahdali H, Alshimemeri A, Mobeireek A, Albanna AS, Al Shirawi NN, Wali S, et al. The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis. Ann Thorac Med. 2017;12(3):135–61.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Martínez-García MA, Perpiñá-Tordera M, Soler-Cataluña JJ, Román-Sánchez P, Lloris-Bayo A, González-Molina A. Dissociation of lung function, dyspnea ratings and pulmonary extension in bronchiectasis. Respir Med. 2007;101(11):2248–53.

    Article  PubMed  Google Scholar 

  28. Martínez-García MÁ, de Gracia J, Vendrell Relat M, Girón RM, Máiz Carro L, de la Rosa CD, et al. Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score. Eur Respir J. 2014;43(5):1357–67.

    Article  PubMed  Google Scholar 

  29. Chalmers JD, Goeminne P, Aliberti S, McDonnell MJ, Lonni S, Davidson J, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med. 2014;189(5):576–85.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Martínez-García MÁ, Athanazio RA, Girón R, Máiz-Carro L, de la Rosa D, Olveira C, de Gracia J, et al. Predicting high risk of exacerbations in bronchiectasis: the E-FACED score. Int J Chron Obstruct Pulmon Dis. 2017;12:275–84.

    Article  PubMed  PubMed Central  Google Scholar 

  31. McDonnell MJ, Aliberti S, Goeminne PC, Dimakou K, Zucchetti SC, Davidson J, et al. Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts. Thorax. 2016;71(12):1110–8.

    Article  CAS  PubMed  Google Scholar 

  32. Martinez-García MÁ, Villa C, Dobarganes Y, Girón R, Maíz L, García-Clemente M, et al. RIBRON: The Spanish Online Bronchiectasis Registry. Characterization of the first 1912 patients. Arch Bronconeumol (Engl Ed). 2021;57(1):28–35.

    Article  PubMed  Google Scholar 

  33. Athanazio R, Pereira MC, Gramblicka G, Cavalcanti-Lundgren F, de Figueiredo MF, Arancibia F, et al. Latin America validation of FACED score in patients with bronchiectasis: an analysis of six cohorts. BMC Pulm Med. 2017;17:73.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Dhar R, Singh S, Talwar D, Mohan M, Tripathi SK, Swarnakar R, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. Lancet Glob Health. 2019;7(9):e1269–79.

    Article  PubMed  Google Scholar 

  35. Díaz López JM, Giran González B, Alcázar-Navarrete B. Personalized medicine in chronic obstructive pulmonary disease: how close are we? Arch Bronconeumol. 2020;56(7):420–1.

    Article  PubMed  Google Scholar 

  36. Celli B, Divo M, Pinto PV. Pharmacotherapy Impacts on COPD mortality. Arch Bronconeumol (Engl Ed). 2021;57(1):5–6.

    Article  PubMed  Google Scholar 

  37. Miravitlles M, Calle M, Soler-Cataluña JJ. GesEPOC 2021: one more step towards personalized treatment of COPD. Arch Bronconeumol (Engl Ed). 2021;57(1):9–10.

    Article  PubMed  Google Scholar 

  38. Boaventura R, Sibila O, Agustí A, Chalmers JD. Treatable traits in bronchiectasis. Eur Respir J. 2018;52(3):1801269.

    Article  PubMed  Google Scholar 

  39. Martínez-García MÁ, Aksamit TR, Agustí A. Clinical fingerprinting: a way to address the complexity and heterogeneity of bronchiectasis in practice. Am J Respir Crit Care Med. 2020;201(1):14–9.

    Article  PubMed  Google Scholar 

  40. Visser SK, Bye PTP, Fox GJ, Burr LD, Chang AB, Holmes-Liew CL, et al. Management of Australian adults with bronchiectasis in tertiary care: evidence-based or access-driven? Lung. 2019;197(6):803–10.

    Article  PubMed  Google Scholar 

  41. Aksamit TR, O’Donnell AE, Barker A, Olivier KN, Winthrop KL, Daniels MLA, et al. Adult patients with bronchiectasis: a first look at the US Bronchiectasis Research Registry. Chest. 2017;151(5):982–92.

    Article  PubMed  Google Scholar 

  42. Martinez-García MÁ, Soler-Cataluña JJ, Perpiñá-Tordera M, Román-Sánchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest. 2007;132(5):1565–72.

    Article  PubMed  Google Scholar 

  43. Martinez-García MÁ, Oscullo G, Posadas T, Zaldivar E, Villa C, Dobarganes Y, et al. Pseudomonas aeruginosa and lung function decline in patients with bronchiectasis. Clin Microbiol Infect. 2021;27(3):428–34.

    Article  PubMed  Google Scholar 

  44. Cazzola M, Page CP, Calzetta L, Matera MG. Pharmacology and therapeutics of bronchodilators. Pharmacol Rev. 2012;64(3):450–504.

    Article  CAS  PubMed  Google Scholar 

  45. Cazzola M, Matera MG. Bronchodilators: current and future. Clin Chest Med. 2014;35(1):191–201.

    Article  PubMed  Google Scholar 

  46. Matera MG, Page CP, Calzetta L, Rogliani P, Cazzola M. Pharmacology and therapeutics of bronchodilators revisited. Pharmacol Rev. 2020;72(1):218–52.

    Article  CAS  PubMed  Google Scholar 

  47. Cazzola M, Calzetta L, Matera MG. Long-acting muscarinic antagonists and small airways in asthma: Which link? Allergy. 2021;76(7):1990–2001.

    Article  CAS  PubMed  Google Scholar 

  48. Sharma RK, Jeffery PK. Airway β-adrenoceptor number in cystic fibrosis and asthma. Clin Sci (Lond). 1990;78(4):409–17.

    Article  CAS  Google Scholar 

  49. Hassan JA, Saadiah S, Roslan H, Zainudin BM. Bronchodilator response to inhaled beta-2 agonist and anticholinergic drugs in patients with bronchiectasis. Respirology. 1999;4(4):423–6.

    Article  CAS  PubMed  Google Scholar 

  50. de Koning GM, Kamphuis LSJ, Hoek RAS, Bakker M, Aerts JGJV, Van Der Eerden MM. Airway hyperresponsiveness in bronchiectasis. Eur Respir J. 2019;54:OA4944.

    Google Scholar 

  51. Regamey N, Ochs M, Hilliard TN, Mühlfeld C, Cornish N, Fleming L, et al. Increased airway smooth muscle mass in children with asthma, cystic fibrosis, and non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2008;177(8):837–43.

    Article  PubMed  Google Scholar 

  52. King PT. The pathophysiology of bronchiectasis. Int J Chron Obstruct Pulmon Dis. 2009;4:411–9.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Martinez-Garcia MA, Miravitlles M. Bronchiectasis in COPD patients: more than a comorbidity? Int J Chron Obstruct Pulmon Dis. 2017;12:1401–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Undem BJ, Kollarik M. The role of vagal afferent nerves in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005;2(4):355–60.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Gosens R, Gross N. The mode of action of anticholinergics in asthma. Eur Respir J. 2018;52(4):1701247.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Kistemaker LE, Gosens R. Acetylcholine beyond bronchoconstriction: roles in inflammation and remodeling. Trends Pharmacol Sci. 2015;36(3):164–71.

    Article  CAS  PubMed  Google Scholar 

  57. Haag S, Matthiesen S, Juergens UR, Racké K. Muscarinic receptors mediate stimulation of collagen synthesis in human lung fibroblasts. Eur Respir J. 2008;32(3):555–62.

    Article  CAS  PubMed  Google Scholar 

  58. Milara J, Serrano A, Peiró T, Artigues E, Gavaldà A, Miralpeix M, et al. Aclidinium inhibits cigarette smoke-induced lung fibroblast-to-myofibroblast transition. Eur Respir J. 2013;41(6):1264–74.

    Article  CAS  PubMed  Google Scholar 

  59. Matera MG, Cazzola M. Muscarinic receptor antagonists. Handb Exp Pharmacol. 2017;237:41–62.

    Article  CAS  PubMed  Google Scholar 

  60. Cazzola M, Calzetta L, Puxeddu E, Ora J, Facciolo F, Rogliani P, et al. Pharmacological characterisation of the interaction between glycopyrronium bromide and indacaterol fumarate in human isolated bronchi, small airways and bronchial epithelial cells. Respir Res. 2016;17(1):70.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Calzetta L, Rogliani P, Page C, Rinaldi B, Cazzola M, Matera MG. Pharmacological characterization of the interaction between tiotropium bromide and olodaterol on human bronchi and small airways. Pulm Pharmacol Ther. 2019;56:39–50.

    Article  CAS  PubMed  Google Scholar 

  62. Chen ZG, Li YY, Wang ZN, Li M, Lim HF, Zhou YQ, et al. Aberrant epithelial remodeling with impairment of cilia architecture in non-cystic fibrosis bronchiectasis. J Thorac Dis. 2018;10(3):1753–64.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Schreurs AJ, Verhoef J, Nijkamp FP. Bacterial cell wall components decrease the number of guinea-pig lung beta-adrenoceptors. Eur J Pharmacol. 1983;87(1):127–32.

    Article  CAS  PubMed  Google Scholar 

  64. Schreurs AJ, Nijkamp FP. Haemophilus influenzae and the beta-adrenergic system: a review. Vet Res Commun. 1984;8(1):1–14.

    Article  CAS  PubMed  Google Scholar 

  65. Cazzola M, Matera MG, Rossi F. Bronchial hyperresponsiveness and bacterial respiratory infections. Clin Ther. 1991;13(1):157–71.

    CAS  PubMed  Google Scholar 

  66. Henry PJ, Rigby PJ, Mackenzie JS, Goldie RG. Effect of respiratory tract viral infection on murine airway beta-adrenoceptor function, distribution and density. Br J Pharmacol. 1991;104(4):914–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Mortensen J, Engel AM, Milman N, Nielsen F, Faurshou P. Inhaled terbutaline improves mucociliary clearance in patients with bronchiectasis. Eur Respir J. 1992;5(Suppl 15):385s.

    Google Scholar 

  68. Saito Y, Azuma A, Morimoto T, Fujita K, Abe S, Motegi T, et al. Tiotropium ameliorates symptoms in patients with chronic airway mucus hypersecretion which is resistant to macrolide therapy. Intern Med. 2008;47(7):585–91.

    Article  PubMed  Google Scholar 

  69. Nogrady SG, Evans WV, Davies BH. Reversibility of airways obstruction in bronchiectasis. Thorax. 1978;33(5):635–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Guan WJ, Gao YH, Xu G, Li HM, Yuan JJ, Zheng JP, et al. Bronchodilator response in adults with bronchiectasis: correlation with clinical parameters and prognostic implications. J Thorac Dis. 2016;8(1):14–23.

    PubMed  PubMed Central  Google Scholar 

  71. Jeong HJ, Lee H, Carriere KC, Kim JH, Han JH, Shin B, et al. Effects of long-term bronchodilators in bronchiectasis patients with airflow limitation based on bronchodilator response at baseline. Int J Chron Obstruct Pulmon Dis. 2016;11:2757–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Lee SY, Lee JS, Lee SW, Oh YM. Effects of treatment with long-acting muscarinic antagonists (LAMA) and long-acting beta-agonists (LABA) on lung function improvement in patients with bronchiectasis: an observational study. J Thorac Dis. 2021;13(1):169–77.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Jayaram L, Vandal AC, Chang C, Lewis C, Tong C, Tuffery C, et al. Tiotropium treatment for bronchiectasis: a randomised, placebo-controlled, crossover trial. Eur Respir J. 2021. https://doi.org/10.1183/13993003.02184-2021. (in press).

  74. Sheikh A, Nolan D, Greenstone M. Long-acting beta-2-agonists for bronchiectasis. Cochrane Database Syst Rev. 2001;4:CD002155.

    Google Scholar 

  75. Lasserson T, Holt K, Evans D, Greenstone M. Anticholinergic therapy for bronchiectasis. Cochrane Database Syst Rev. 2001;4:CD002163.

    Google Scholar 

  76. Franco F, Sheikh A, Greenstone M. Short acting beta-2 agonists for bronchiectasis. Cochrane Database Syst Rev. 2003;3:CD003572.

    Google Scholar 

  77. Goyal V, Chang AB. Combination inhaled corticosteroids and long-acting beta2-agonists for children and adults with bronchiectasis. Cochrane Database Syst Rev. 2014;6:CD010327.

    Google Scholar 

  78. Martínez-García MÁ, Soler-Cataluña JJ, Catalán-Serra P, Román-Sánchez P, Tordera MP. Clinical efficacy and safety of budesonide-formoterol in non-cystic fibrosis bronchiectasis. Chest. 2012;141(2):461–8.

    Article  PubMed  Google Scholar 

  79. Yeh JJ, Yang YC, Hsu CY, Kao CH. Effect of bronchodilator and steroid use on heart disease and stroke risks in a bronchiectasis-chronic obstructive pulmonary disease overlap cohort: a propensity score matching study. Front Pharmacol. 2019;10:1409.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Lee JK, Lee J, Park SS, Heo EY, Park YS, Lee CH, et al. Effect of inhalers on the development of haemoptysis in patients with non-cystic fibrosis bronchiectasis. Int J Tuberc Lung Dis. 2014;18(3):363–70.

    Article  PubMed  Google Scholar 

  81. Jang EJ, Lee CH, Yoon HI, Kim YJ, Kim JM, Choi SM, et al. Association between inhaler use and risk of haemoptysis in patients with on-cystic fibrosis bronchiectasis. Respirology. 2015;20(8):1213–21.

    Article  PubMed  Google Scholar 

  82. Li XL, Cai SX, Zhao HJ, Dong LM, Shen XB, Liu LY, et al. Therapeutic effect of tiotropium bromide powder inhalation in patients with stable bronchiectasis (Chinese). Nan Fang Yi Ke Da Xue Xue Bao. 2010;30(5):1072–4.

    PubMed  Google Scholar 

  83. Cazzola M, Rogliani P, Matera MG. The future of bronchodilation: looking for new classes of bronchodilators. Eur Respir Rev. 2019;28(154):190095.

    Article  PubMed  Google Scholar 

  84. Cazzola M, Page C, Calzetta L, Matera MG. Ensifentrine (RPL554): an inhaled “bifunctional” dual PDE3/4 inhibitor for the treatment of asthma and chronic obstructive pulmonary disease. Pharm Pat Anal. 2018;7(6):249–57.

    Article  CAS  PubMed  Google Scholar 

  85. Calzetta L, Cazzola M, Page CP, Rogliani P, Facciolo F, Matera MG. Pharmacological characterization of the interaction between the dual phosphodiesterase (PDE) 3/4 inhibitor RPL554 and glycopyrronium on human isolated bronchi and small airways. Pulm Pharmacol Ther. 2015;32:15–23.

    Article  CAS  PubMed  Google Scholar 

  86. Calzetta L, Coppola A, Ritondo BL, Matino M, Chetta A, Rogliani P. The impact of muscarinic receptor antagonists on airway inflammation: a systematic review. Int J Chron Obstruct Pulmon Dis. 2021;16:257–79.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Cazzola M, Rogliani P, Matera MG. The latest on the role of LAMAs in asthma. J Allergy Clin Immunol. 2020;146(6):1288–91.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Respiratory Department, Polytechnic and University La Fe Hospital, Valencia, Spain

    Miguel Ángel Martínez-García, Grace Oscullo & Alberto García-Ortega

  2. CIBERES de Enfermedades Respiratorias, Madrid, Spain

    Miguel Ángel Martínez-García

  3. Unit of Pharmacology, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Maria Gabriella Matera

  4. Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy

    Paola Rogliani & Mario Cazzola

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  1. Miguel Ángel Martínez-García
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MÁM-G: conceptualisation, supervision, writing—original draft, writing—review and editing. GO: systematic clinical review of the literature, writing—review and editing. AG-O: systematic clinical review of the literature, writing—review and editing. MGM: validation, writing—review and editing. PR: validation, writing—review and editing. MC: conceptualisation, supervision, writing—original draft, writing—review and editing.

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Martínez-García, M.Á., Oscullo, G., García-Ortega, A. et al. Rationale and Clinical Use of Bronchodilators in Adults with Bronchiectasis. Drugs 82, 1–13 (2022). https://doi.org/10.1007/s40265-021-01646-3

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