Marousa Kouvela
Bronchodilators play a central role in COPD treatment. At the end of the previous year, the GOLD (Global Initiative for Chronic Obstructive Lung Disease) strategy for the diagnosis, management and prevention of COPD has been updated and published with several changes. One of the most important changes was the shift of the treatment recommendations towards the maximization of bronchodilative therapy to all COPD patients and the restriction of inhaled corticosteroid (ICS) use to more specific patient groups, although, the ICS overuse continues to be an issue in many countries worldwide. The direct comparison of inhaled LABA/LAMA combinations with their monocomponents or a LABA/ICS combination shows superiority of the LABA/LAMA combination in case of lung function, symptoms and quality of life. Recently, there has been a question whether a LABA/LAMA combination is equally or even more efficient than a LABA/ICS combination therapy in the prevention of COPD exacerbations. Another question that needs to be clarified is how safe it is to withdraw ICS from the patients that do not need them and how this is applicable in everyday clinical practice. It seems that a LABA/LAMA combination is a very efficient and safe treatment option to all COPD groups and it should be applied from the beginning of COPD treatment. The efficacy of double bronchodilation is mainly attributed to the reduction of the lung hyperinflation, the enhancement of mucociliary clearance and their anti-inflammatory properties. Moreover, it seems that the simultaneous administration of two bronchodilators offers a synergic action to the lungs.