Letter to the Editor
Double or Dual Bronchodilation: Defining the Correct Term
Broncodilatación doble o dual: definiendo el término correcto
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=> "López-Campos" "email" => array:1 [ 0 => "lcampos@separ.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Abad-Arranz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Carmen" "apellidos" => "Calero-Acuña" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Broncodilatación doble o dual: definiendo el término correcto" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">For some time, pharmacological treatment of chronic obstructive pulmonary disease (COPD) has been based on bronchodilation. Current guidelines recommend the use of a long-acting bronchodilator (LABD) as initial therapy for this disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The guidelines also recommend adding a second LABD of a different class in specific cases to boost the clinical effect of improved bronchodilation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In recent years, ample scientific evidence and clinical experience has led to the acceptance of the novel approach of combining 2 LABDs in a single device.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As in all new ideas, the concepts under consideration must be well defined to avoid confusion. This new treatment modality is currently known as dual bronchodilation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Yet the term “dual” implies a single substance with 2 different features or properties,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> while “double” describes a combination of 1 compound with another similar compound, that work together with the same aim.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> While a first reading might suggest that both terms have a similar meaning, there is a nuance that must be understood when discussing bronchodilators.</p><p id="par0015" class="elsevierStylePara elsevierViewall">When 2 LABDs are administered together, we are in fact giving 2 different molecules. They are similar, in that they are both bronchodilators, but each one has its own characteristic pharmacology that works with the other to achieve the same objective: dilate the bronchi. Thus, the most accurate term for this treatment modality would be “double”. Indeed, according to the above-mentioned definition, a dual bronchodilator would be one that was capable of doing the work of two. These bronchodilators include the so-called muscarinic antagonist and β<span class="elsevierStyleInf">2</span> agonists (MABA). MABAs are a new family of molecules that really do have dual activity: they block muscarinic receptors, while simultaneously inhibiting β<span class="elsevierStyleInf">2</span> adrenergic receptors.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Curiously, this new family of molecules has also been described in the literature as a dual bronchodilator,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> thus adding to the confusion. However, the mechanism of action of MABAs is completely different to bronchodilation achieved by the concomitant administration of 2 different LABDs, and, according to the above-mentioned definition, they may be authentically considered dual bronchodilation. We propose, then, using the term “double” to refer to the combined administration of 2 LABDs, and reserving the term “dual” for MABAs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-Campos JL, Abad-Arranz M, Calero-Acuña C. Broncodilatación doble o dual: definiendo el término correcto. Arch Bronconeumol. 2015;51:661.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish guideline for COPD (GesEPOC). Update 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J.J. Soler-Cataluna" 2 => "M. Calle" 3 => "J. Molina" 4 => "P. Almagro" 5 => "J.A. Quintano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2014" "volumen" => "50" "numero" => "Suppl. 1" "paginaInicial" => "S1" "paginaFinal" => "S16" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COPD: maximization of bronchodilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Nardini" 1 => "G. Camiciottoli" 2 => "S. Locicero" 3 => "R. Maselli" 4 => "F. Pasqua" 5 => "G. Passalacqua" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/2049-6958-9-50" "Revista" => array:5 [ "tituloSerie" => "Multidiscip Respir Med" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25364503" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical benefit of fixed-dose dual bronchodilation with glycopyrronium and indacaterol once daily in patients with chronic obstructive pulmonary disease: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.S. Ulrik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/COPD.S60362" "Revista" => array:6 [ "tituloSerie" => "Int J Chron Obstruct Pulmon Dis" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "331" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24729699" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diccionario de la lengua española" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Real Academia Española" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "22nd ed." "fecha" => "2001" "editorial" => "Espasa Calpe" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multivalent dual pharmacology muscarinic antagonist and β<span class="elsevierStyleInf">2</span> agonist (MABA) molecules for the treatment of COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.D. Hughes" 1 => "A. McNamara" 2 => "T. Steinfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/B978-0-12-396493-9.00003-0" "Revista" => array:6 [ "tituloSerie" => "Prog Med Chem" "fecha" => "2012" "volumen" => "51" "paginaInicial" => "71" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22520472" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000012/v1_201512080104/S1579212915003195/v1_201512080104/en/main.assets" "Apartado" => array:4 [ "identificador" => "45358" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000012/v1_201512080104/S1579212915003195/v1_201512080104/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003195?idApp=UINPBA00003Z" ]
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