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Dr Marousa Kouvela is a Pulmonologist. She completed her residency in one of the largest general hospitals in Greece and achieved her speciality board degree in 2013. She has completed her Master of Science in Thoracic Oncology. She has participated in many Natiaonal and International scientific and educational seminars, and published in national and international journals. Her special scientific interests are COPD, lung cancer and interventional pulmonology. She currently work as a Medical Manager Respiratory in Boehringer Ingelheim Ellas, Greece.
Bronchodilators play a central role in COPD treatment. At the end of the previous year, the GOLD (Global Initiative for Global 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 toward the maximization of bronchodialative therapy to all COPD patients and the restriction of ICS use to more specific patient groups, although, the ICS overuse continues to be an issue to many countries worldwide. The direct comparison of inhaled LABA/LAMA combinations to the nanocomponents 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 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 very efficient and safe treatment option to all COPD groups and it should be applied from the beginning of COPD treatment. The efficacy of the 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.