Recent developments in inhaled therapy in stable chronic obstructive pulmonary disease

Cooper, C.B.; Tashkin, Donald P.

doi:10.1136/bmj.330.7492.640

Cited by 35 publications

(18 citation statements)

References 26 publications

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“…Nonetheless, Cooper and Tashkin (2005) have described a more explicit and practical patient oriented approach to the hierarchical implementation of pharmacotherapy in COPD. They have proposed a clinical treatment algorithm based on the clinical stage of disease regardless of disease stage or lung function.…”

Section: Labas In Copd Guidelinesmentioning

confidence: 99%

Long-acting β<sub>2</sub>-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety

Rossi

Khirani²,

Cazzola³

2008

COPD

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COPD is characterized by progressive airflow obstruction which does not fully reverse to inhaled or oral pharmacotherapy. The management of patients with COPD has taken a totally new direction over the past 20 years, thank to the use of novel therapies aimed to improve and modify the natural history of COPD. Long-acting bronchodilators, including long-acting β2-agonists (LABAs), were introduced several years ago in order to enhance improvements in lung function, health status related quality of life, and reduce the rate of exacerbations. These effects can be boosted by the combination of LABAs with long-acting anticholinergic, and/or with inhaled corticosteroids. Inhaled LABAs are commonly well tolerated although adverse effects such as tremor and palpitations are occasionally troublesome.

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Section: Labas In Copd Guidelinesmentioning

confidence: 99%

Long-acting β<sub>2</sub>-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety

Rossi

Khirani²,

Cazzola³

2008

COPD

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“…Chronic obstructive pulmonary disease (COPD) is a common condition in which airway obstruction may be partially reversed by inhaled bronchodilators [1]. Anticholinergic bronchodilators are particularly effective in COPD and are recommended in current treatment guidelines [2].…”

Section: Introductionmentioning

confidence: 99%

Lung Deposition of Aclidinium Bromide from Genuair®, a Multidose Dry Powder Inhaler

Newman¹,

Sutton²,

Segarra³

et al. 2009

Respiration

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Background: Aclidinium bromide is a novel, long-acting inhaled muscarinic antagonist currently in development for the treatment of chronic obstructive pulmonary disease (COPD). A next-generation multidose dry powder inhaler will be used for the delivery of aclidinium bromide. Objectives: To quantify whole lung deposition and regional lung deposition of aclidinium delivered by a multidose dry powder inhaler (Genuair®) in healthy subjects. Methods: A single dose (200 μg) of aclidinium bromide, radiolabelled with ^99mTc, was administered from the multidose dry powder inhaler at a targeted peak inspiratory flow rate (PIFR) of 90 litres/min in 12 healthy males (18–63 years). Gamma scintigraphy was used to quantify drug deposition in the lungs and oropharynx, as well as amounts retained in the inhaler and exhaled. The quantities of drug deposited in 6 concentric regions within the lungs were also determined. Results: The mean (± SD) PIFR was 79.0 ± 9.4 litres/min. The mean (± SD) percentages of the metered dose deposited in the whole lung and oropharynx were 30.1 ± 7.3 and 54.7 ± 7.2%, respectively. Deposition of aclidinium occurred in all 6 lung zones, but was highest in the most central zone. Conclusions: These results demonstrated that the multidose dry powder inhaler delivered aclidinium efficiently to the lungs. The whole lung deposition seen in this study is an indication of the likely whole lung deposition in COPD patients who inhale with similar PIFRs; however, further studies in patients are required to confirm this.

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“…Three long-acting (12-24 hours in duration) bronchodilators (formoterol, salmeterol, and tiotropium) have been shown to be effective and well tolerated for the management of COPD. Because of the convenient dosing and improved, sustained efficacy of long-acting bronchodilators compared with short-acting bronchodilators, clinicians have proposed that long-acting bronchodilator combination therapy should be a standard-ofcare component for patients with symptomatic COPD, especially those with a history of exacerbations [2,[45][46][47]. It has been proposed that combining long-acting bronchodilators with different mechanisms of action may result in increased efficacy and improved safety profiles compared with increasing doses of one long-acting agent.…”

Section: Discussionmentioning

confidence: 99%

Bronchodilator Combination Therapy for the Treatment of Chronic Obstructive Pulmonary Disease

Sethi¹,

Côté²

2011

CCP

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Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, and its prevalence is rising worldwide. Bronchodilators remain the cornerstone of COPD treatment, especially inhaled β2-adrenergic receptor agonists and inhaled anticholinergics. Long-acting bronchodilators are considered more effective and convenient than short-acting bronchodilators for the maintenance treatment in patients with moderate to very severe COPD. There are currently 3 long-acting inhaled bronchodilators available in the United States: the β2-adrenergic receptor agonists formoterol and salmeterol, and the anticholinergic, tiotropium. All 3 long-acting bronchodilators have been shown to be effective and well tolerated for the management of patients with stable COPD in clinical studies. The combination of β2-adrenergic receptor agonists and anticholinergics has been shown to provide superior bronchodilatory effect than either agent alone, possibly because of different mechanisms of action of these agents. The current treatment guidelines recommend the use of one or more long-acting bronchodilators for patients with moderate to severe stable COPD who remain symptomatic with single-agent bronchodilator therapy. The objective of this article is to review clinical data on combined bronchodilator therapy with β2-adrenergic receptor agonists and anticholinergics in patients with COPD.

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Recent developments in inhaled therapy in stable chronic obstructive pulmonary disease

Cited by 35 publications

References 26 publications

Long-acting β<sub>2</sub>-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety

Long-acting β<sub>2</sub>-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety

Lung Deposition of Aclidinium Bromide from Genuair®, a Multidose Dry Powder Inhaler

Bronchodilator Combination Therapy for the Treatment of Chronic Obstructive Pulmonary Disease

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Recent developments in inhaled therapy in stable chronic obstructive pulmonary disease

Cited by 35 publications

References 26 publications

Long-acting &beta;<sub>2</sub>-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety

Long-acting &beta;<sub>2</sub>-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety

Lung Deposition of Aclidinium Bromide from Genuair®, a Multidose Dry Powder Inhaler

Bronchodilator Combination Therapy for the Treatment of Chronic Obstructive Pulmonary Disease

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Product

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Long-acting β<sub>2</sub>-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety

Long-acting β<sub>2</sub>-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety