Effectiveness of glycopyrronium bromide in the treatment of small airway dysfunction: A retrospective study

Albino Petrone; Corrado Pelaia; Michela Quartieri; Ludovico Petrone; Giuseppe Francesco Rago; Clementina Columbro; Girolamo Pelaia

doi:10.1177/20503121221145605

Effectiveness of glycopyrronium bromide in the treatment of small airway dysfunction: A retrospective study

SAGE Open Med. 2022 Dec 23:10:20503121221145605. doi: 10.1177/20503121221145605. eCollection 2022.

Authors

Albino Petrone¹, Corrado Pelaia², Michela Quartieri¹, Ludovico Petrone², Giuseppe Francesco Rago¹, Clementina Columbro¹, Girolamo Pelaia²

Affiliations

¹ Department of Respiratory Diseases, Annunziata Hospital, Cosenza, Italy.
² Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.

Abstract

Objective: Glycopyrronium bromide has a quaternary ammonium structure and a low oral bioavailability, which reduces its systemic effects; it acts through a bronchodilating blockade of muscarinic receptors. The aim of this retrospective study was to analyze a possible relationship between the changes in the small airways and the efficacy of a bronchodilation with glycopyrronium bromide; exercise tolerance was also assessed, by performing the six-minute walking test.

Methods: Forty-one patients were identified (23 females/18 males; mean age 66.82 ± 9.75 years), with a normal forced expiratory volume in 1 s (FEV₁)/forced vital capacity ratio of 77.45% ± 4.86%, a reduced forced mid-expiratory flow between 25% and 75% of forced vital capacity (FEF_25-75) of 42.9% ± 10.5%, with an increased residual volume/total lung capacity ratio of 132.68% ± 6.41%, FEV₁ 1.85 ± 0.54 L, forced vital capacity 2.39 ± 0.71 L, airway resistance (sR tot) 168.18% ± 42.5%, total lung capacity 98.28% ± 8.9%, six-minute walking test distance 318.3 ± 36.6 m, modified British Medical Research Council dyspnea scale 1.48 ± 0.77. All patients were initiated with glycopyrronium bromide 50 μg/die and reassessed after 4 months.

Results: After the treatment with glycopyrronium bromide, a significant improvement was noted regarding forced vital capacity (p = 0.04), FEF_25-75 (p < 0.001), sR tot (p < 0.001), residual volume/total lung capacity ratio (p < 0.001) with reduction of dynamic hyperinflation, the significant increase of the distance covered during the six-minute walking test (p < 0.001), and modified British Medical Research Council (p < 0.001) showed enhanced exercise tolerance. FEV₁ improved, but the difference was not statistically significant.

Conclusions: Small airway dysfunction is associated with bronchodilator responsiveness. Glycopyrronium bromide has proven to be capable of inducing favorable effects on lung hyperinflation and its functional and clinical consequences, with a decrease in dyspnea and an increase in exercise capacity. The use of anticholinergic drugs is useful in the management of small airway disease.

Keywords: Anticholinergic drugs; COPD; bronchodilator; glycopyrronium bromide; small airway.