How do we critically use long-acting muscarinic receptor antagonists and beta- adrenergic receptor agonists monotherapy, or these combination therapies.

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How do we critically use long-acting muscarinic receptor antagonists and beta- adrenergic receptor agonists monotherapy, or these combination therapies depending on the situation in Japanese patients with COPD? Tomotaka Kawayama, Jun Sasaki Respiratory Investigation Volume 55, Issue 6, Pages 323-325 (November 2017) DOI: 10.1016/j.resinv.2017.09.002 Copyright © 2017 The Japanese Respiratory Society Terms and Conditions

Fig. 1 Pharmacologic treatment algorithms by GOLD grade [1]. Group C has a small population of patients. * Rofumilast, macrolide, and ICS monotherapy are not accepted in patients with COPD in Japan. ICS = inhaled corticosteroids, LABA = beta adrenergic receptor agonists, LAMA = long-acting muscarinic receptor antagonists. Respiratory Investigation 2017 55, 323-325DOI: (10.1016/j.resinv.2017.09.002) Copyright © 2017 The Japanese Respiratory Society Terms and Conditions

Fig. 2 Functional crosstalk between β2-adrenoreceptor and muscarinic acetylcholine receptor [3]. Gα proteins (α-subunit of G protein) are classified into four major subtypes: Gq-, Gs-, Gi- and G12/13. AC = adenylate cyclase, ATP = Adenosine triphosphate, β2AR = β2-adrenoreceptor, cAMP = cyclic adenosine monophosphate, DAG = 1,2-diacylglycerol, GPCRs = guanine nucleotide-binding protein (G protein) coupled receptors, GTP = guanosine triphosphate, IP3 = 1,4,5-triphosphate, M2 and M3 mAchR = muscarinic acetylcholine receptor 2 and 3, MLC = myosin light chain, MLCK = myosin light chain kinase, MLCP = myosin light chain phosphatase, PI-4 = Phosphatidylinositol 4-phosphate, PKA = protein kinase A, PKC = protein kinase C, PLCβ = phospholipase C-β. Respiratory Investigation 2017 55, 323-325DOI: (10.1016/j.resinv.2017.09.002) Copyright © 2017 The Japanese Respiratory Society Terms and Conditions