Pharmacological treatment of chronic obstructive pulmonary disease

Abstract

None of the drugs currently available for chronic obstructive pulmonary disease (COPD) are able to reduce the progressive decline in lung function which is the hallmark of this disease. Smoking cessation is the only intervention that has proved effective. The current pharmacological treatment of COPD is symptomatic and is mainly based on bronchodilators, such as selective β2-adrenergic agonists (short- and long-acting), anticholinergics, theophylline, or a combination of these drugs. Glucocorticoids are not generally recommended for patients with stable mild to moderate COPD due to their lack of efficacy, side effects, and high costs. However, glucocorticoids are recommended for severe COPD and frequent exacerbations of COPD. New pharmacological strategies for COPD need to be developed because the current treatment is inadequate.

New Pharmacological Treatments for Patients With Chronic Obstructive Pumonary Disease (Copd)

“…These long-acting bronchodilators have a significantly positive effect on FEV1, lung volumes, dyspnea, exacerbation rate and quality of life [12][13][14][15][16] . Since inflammation in patients with COPD is, at least partly, corticosteroid-resistant, due to a reduced activity of the histone deacetylase the use of glucocorticosteroids (GCs) remains controversial 10,12,[16][17][18][19][20][21] . However, this treatment is recommended for moderate/severe COPD rather than mild COPD since there is no other therapeutic option 10,13 .…”

“…However, this treatment is recommended for moderate/severe COPD rather than mild COPD since there is no other therapeutic option 10,13 . A large clinical trial has shown improvements in lung function, and decreased exacerbation frequency in individuals receiving combined inhaled GC and LABA treatment versus placebo and oral GC therapy is also recommended for the treatment of COPD exacerbations [10][11][12][13][18][19][20][21] . The use of theophyllines has been associated with a reduction in the rate of COPD exacerbations compared with long-acting β2-agonists among COPD patients.…”

“…At present, LABAs are administered twice daily; nonetheless, in order to improve adherence, several once daily formulations of LABAs are in clinical development, the most promising are carmoterol and indacaterol [19][20][21] .…”

“…Leukotriene (LT) B4 is increased in sputum and bronchoalveolar lavage fluid of patients with COPD and is chemotactic for neutrophils and lymphocytes 3,[16][17][18][19] . Several antagonists of the major receptor BLT1 have developed, but so far clinical studies in COPD have been negative.…”

“…A small molecule inhibitor of NE, ZD0892, was tested in animal models and reduced tobacco smokeinduced emphysema 36 . At present, there are nebulized inhibitors of NE in clinical development, but so far all have failed in clinical trials 18,19 . The selective MMP-12 inhibitor AS111793 was tested in smoking mice and reduced the inflammatory process associated with exposure of mice to cigarette smoke 36 .…”