Combination therapy of long-acting β agonists and inhaled corticosteroids in the management of chronic asthma

Nelson, Harold S.

doi:10.1007/s11882-005-0085-x

Cited by 11 publications

(6 citation statements)

References 40 publications

(39 reference statements)

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“…Combination therapy improves symptom control and adherence. 215,216 Step 7. Evaluate systemic corticosteroid pharmacokinetics to maximize pulmonary function with oral corticosteroids.…”

Section: Management Of Glucocorticoid Resistancementioning

confidence: 99%

Update on glucocorticoid action and resistance

Ito

Chung

Adcock

2006

Journal of Allergy and Clinical Immunology

347

312

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“…Combination therapy improves symptom control and adherence. 215,216 Step 7. Evaluate systemic corticosteroid pharmacokinetics to maximize pulmonary function with oral corticosteroids.…”

Section: Management Of Glucocorticoid Resistancementioning

confidence: 99%

Update on glucocorticoid action and resistance

Ito

Chung

Adcock

2006

Journal of Allergy and Clinical Immunology

347

312

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“…The current consensus is that β 2 ‐AR agonists do not have direct anti‐inflammatory properties. However, there is convincing evidence from both basic and clinical studies that the use of β 2 ‐AR agonists in combination with inhaled steroids provides a control of asthma symptoms that is far better than with the use of either agent alone, suggesting synergism ( Nelson, 2005 ). In a recent study, in a human bronchial epithelial cell line, β 2 ‐AR agonists caused an enhancement of the level of glucocorticoid response element‐dependent transcription by corticosteroids to levels 2–3 times greater than that achieved by corticosteroids alone ( Kaur et al ., 2008 ).…”

Section: Drugs Used In Sport Acting Directly On β‐Arsmentioning

confidence: 99%

The rush to adrenaline: drugs in sport acting on the β‐adrenergic system

Davis

Loiacono

Summers

2008

British J Pharmacology

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Athletes attempt to improve performance with drugs that act on the b-adrenergic system directly or indirectly. Of three b-adrenoceptor (AR) subtypes, the b 2 -AR is the main target in sport; they have bronchodilator and anabolic actions and enhance anti-inflammatory actions of corticosteroids. Although demonstrable in animal experiments and humans, there is little evidence that these properties can significantly improve performance in trained athletes. Their actions may also be compromised by receptor desensitization and by common, naturally occurring receptor mutations (polymorphisms) that can influence receptor signalling and desensitization properties in individuals. Indirectly acting agents affect release and reuptake of noradrenaline and adrenaline, thereby influencing all AR subtypes including the three b-ARs. These agents can have potent psychostimulant effects that provide an illusion of better performance that does not usually translate into improvement in practice. Amphetamines and cocaine also have considerable potential for cardiac damage. b-AR antagonists (b-blockers) are used in sports that require steadiness and accuracy, such as archery and shooting, where their ability to reduce heart rate and muscle tremor may improve performance. They have a deleterious effect in endurance sports because they reduce physical performance and maximum exercise load. Recent studies have identified that many b-AR antagonists not only block the actions of agonists but also activate other (mitogen-activated PK) signalling pathways influencing cell growth and fate. The concept that many compounds previously regarded as 'blockers' may express their own spectrum of pharmacological properties has potentially far-reaching consequences for the use of drugs both therapeutically and illicitly. Keywords: b-adrenoceptor; b-blocker; polymorphism; ergogenic; sympathomimetic; clenbuterol; salbutamol; ephedrine Abbreviations: AR, adrenoceptor; Gs, stimulatory G-protein; Erk1/2, extracellular-signal regulated kinase; TNFa, tumour necrosis factor a There has been considerable interest expressed in the use of drugs by athletes to improve performance. As the physiological secretion of adrenaline into the bloodstream in response to stress, fright or physical exercise undeniably affects performance, it is not surprising that a number of categories of drugs that are used by some athletes to alter performance have their effects on the adrenergic system. The main categories of drugs acting on the adrenergic system that have been used acutely include stimulants such as cocaine, amphetamines and ephedrine (see Docherty, 2008), and blockers such as the b-AR antagonists (The World Anti-Doping Code-The 2008 Prohibited List International Standard). Most of the desired effects are produced by these drugs acting directly or indirectly on b-ARs both in the brain and in peripheral tissues. More recently, b-AR agonists have been used as anabolic agents to increase body weight and build muscle strength. This review will examine not only the characteri...

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“…Both the GINA [66] and the NAEPP [65] Expert Panel guidelines recommend combination treatment with ICs and LABAs for patients whose asthma is not adequately controlled by low doses of ICs alone. There is suggestive evidence that the results with ICs and LABAs may be more than additive effects and several articles are published on pharmacoeconomics of combination therapy [92][93][94][95][96]. ICs and LABAs are classes of drugs with different mechanisms of action that are commonly used to provide effective long-term control of persistent asthma.…”

Section: Pharmacoeconomicsmentioning

confidence: 99%