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European Respiratory Review : An... Sep 2014The burden of chronic obstructive pulmonary disease (COPD) is considerable, both socially and economically. Central to COPD management is the use of long-acting... (Review)
Review
The burden of chronic obstructive pulmonary disease (COPD) is considerable, both socially and economically. Central to COPD management is the use of long-acting bronchodilators, which provide patients with optimal bronchodilation and improvements in symptoms. The once-daily, long-acting β2-agonist indacaterol, the long-acting muscarinic antagonist glycopyrronium, and the indacaterol/glycopyrronium fixed-dose combination QVA149 have all been shown to significantly improve lung function and patient-reported outcomes. The ability to take medication appropriately is important. Easy to use, low resistance devices may help patients take their medication and achieve good drug deposition. There is a need to optimise COPD management by treating the right patients with the right therapy at the right time during the course of their disease. Herein, we present a view on the current COPD management landscape and current unmet needs, and look to the future of COPD treatment and how patient care can be optimised.
Topics: Asthma; Bronchodilator Agents; Diagnosis, Differential; Humans; Pulmonary Disease, Chronic Obstructive
PubMed: 25176969
DOI: 10.1183/09059180.00004014 -
American Family Physician Jan 2017
Review
Topics: Administration, Inhalation; Bronchodilator Agents; Cholinergic Antagonists; Humans; Pulmonary Disease, Chronic Obstructive; Quinuclidines; Treatment Outcome
PubMed: 28084712
DOI: No ID Found -
Journal of Veterinary Internal Medicine 2024Salbutamol and hyoscine butylbromide (HBB) are commonly used bronchodilators in horses with severe asthma (SA). (Comparative Study)
Comparative Study
BACKGROUND
Salbutamol and hyoscine butylbromide (HBB) are commonly used bronchodilators in horses with severe asthma (SA).
OBJECTIVE
To compare the bronchodilation potency, duration, and adverse effects of salbutamol and HBB in SA.
ANIMALS
Six horses in exacerbation of SA.
METHODS
The effects of inhaled salbutamol (1000 μg) and HBB (150 mg, IV) were compared in a randomized, blinded, crossover experiment. Lung function, intestinal borborygmi and heart rate were assessed before and sequentially until 180 minutes after drug administration, and analyzed with 2-way repeated-measures ANOVA and Dunnett's multiple comparison tests.
RESULTS
Both treatments caused a similar improvement in lung function. Pulmonary resistance and reactance returned to baseline values within 30 minutes after HBB administration, whereas salbutamol improved reactance until 180 minutes (mean improvement at 180 minutes of 0.040 Kpa/L/s, 95% CI = 0.004 to 0.076; P = .02 for salbutamol and of 0.009 Kpa/L/s, 95% CI = -0.028 to 0.045; P = .98 for HBB for the resistance at 3 Hz and of 0.040 Kpa/L/s, 95% CI = 0.007 to 0.074; P = .01 for salbutamol and of 0.009 Kpa/L/s, 95% CI = -0.024 to 0.042; P = .97 for HBB for the reactance at 7 Hz). From 5 to 30 minutes after HBB administration, the heart rate accelerated (mean increase of 3.3 beats per minute, 95% CI = -6.6 to 13.1; P = .92 for salbutamol, and of 13.0 beats per minute, 95% CI = 3.6 to 22.4; P = .002 for HBB at 30 minutes) and the gut sounds decreased (mean reduction of 1.3, 95% CI = -0.1 to 2.8; P = .09 for salbutamol and of 2.8 for the gastrointestinal auscultation score, 95% CI = 1.4 to 4.3; P < .0001 for HBB at 30 minutes).
CONCLUSIONS AND CLINICAL IMPORTANCE
Both drugs have a similar bronchodilator potency but with a longer duration for salbutamol. Gastrointestinal and cardiovascular effects were noted only with HBB, suggesting the preferential use of salbutamol to relieve bronchoconstriction in horses with asthma.
Topics: Animals; Horses; Albuterol; Asthma; Horse Diseases; Bronchodilator Agents; Cross-Over Studies; Butylscopolammonium Bromide; Male; Female; Heart Rate; Administration, Inhalation
PubMed: 38609079
DOI: 10.1111/jvim.17057 -
The European Respiratory Journal Sep 2009Bronchodilators remain central to the symptomatic management of chronic obstructive pulmonary disease and asthma, and, for this reason and also because the patent... (Review)
Review
Bronchodilators remain central to the symptomatic management of chronic obstructive pulmonary disease and asthma, and, for this reason and also because the patent protection of many bronchodilators has expired, several companies have reinitiated research into the field. The only limits set for the development of a long-lasting bronchodilator with a new product profile are medical needs and marketing opportunities. The incorporation of once-daily dose administration is an important strategy for improving adherence and is a regimen preferred by most patients. A variety of beta(2)-agonists and antimuscarinic agents with longer half-lives and inhalers containing a combination of several classes of long-acting bronchodilator are currently under development. The present article reviews all of the most important compounds under development, describing what has been done and discussing their genuine advantage.
Topics: Administration, Inhalation; Adrenergic Agents; Asthma; Bronchodilator Agents; Drug Administration Schedule; Humans; Pulmonary Disease, Chronic Obstructive
PubMed: 19720811
DOI: 10.1183/09031936.00013109 -
The European Respiratory Journal Jun 2022
Topics: Bronchiectasis; Bronchodilator Agents; Cross-Over Studies; Humans; Tiotropium Bromide
PubMed: 35680152
DOI: 10.1183/13993003.03127-2021 -
Canadian Respiratory Journal 2018Asthma is a chronic disease of airway inflammation with a large global burden. Despite established, guideline-based stepwise therapy, a significant proportion of... (Review)
Review
Asthma is a chronic disease of airway inflammation with a large global burden. Despite established, guideline-based stepwise therapy, a significant proportion of patients remain symptomatic and poorly controlled. As such, there is a need for additional safe, effective, convenient, and cost-effective therapies that can be broadly applied across a range of asthma phenotypes. Tiotropium is a long-acting muscarinic antagonist (LAMA) that leads to bronchodilation by blocking endogenous acetylcholine receptors in the airways. Tiotropium has long been approved for the treatment of chronic obstructive pulmonary disease, and it has recently been recognized for its safety and efficacy in improving lung function and controlling asthma. Evidence from several Phase III trials in the adult and paediatric population has shown that tiotropium is well tolerated and significantly improves a range of endpoints as an add-on treatment to ICS therapy, regardless of baseline characteristics and clinical phenotypes. Consequently, regulatory authorities worldwide have recently licensed tiotropium as the only LAMA approved for the treatment of asthma. This review provides an overview of safety and efficacy data and discusses the use of tiotropium in patients across the range of asthma severities, ages, and phenotypes.
Topics: Asthma; Bronchodilator Agents; Humans; Patient Selection; Tiotropium Bromide
PubMed: 29670674
DOI: 10.1155/2018/3464960 -
Pulmonary Pharmacology & Therapeutics Aug 2017In this review, we summarize the rationale for combining long-acting bronchodilators in the management of chronic obstructive pulmonary disease (COPD), and the evidence... (Review)
Review
In this review, we summarize the rationale for combining long-acting bronchodilators in the management of chronic obstructive pulmonary disease (COPD), and the evidence for the long-acting bronchodilator combination indacaterol/glycopyrronium (IND/GLY). Clinical practice guidelines generally recommend the use of long-acting bronchodilators in the treatment of patients with all severities of COPD, either as a first-choice or alternative-choice therapy. Combining classes of long-acting bronchodilators can result in superior improvements in lung function and clinical outcomes compared with bronchodilator monotherapy, as observed in studies of free combinations of long-acting β-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs). LABA/LAMA fixed-dose combinations (FDCs) can also significantly improve lung function, dyspnea, symptoms and health status and reduce exacerbations and rescue medication use versus an inhaled corticosteroid/LABA, with a comparable safety profile and lower incidence of pneumonia. The LABA/LAMA FDC of IND/GLY is approved for use in the management of COPD. This review summarizes the evidence for IND/GLY, including its pharmacodynamic and pharmacokinetic profile, and published efficacy and safety data from clinical trials in patients with COPD. We also explore the unmet needs in COPD and discuss the potential future of COPD management.
Topics: Administration, Inhalation; Adrenergic beta-2 Receptor Agonists; Animals; Bronchodilator Agents; Drug Combinations; Glucocorticoids; Glycopyrrolate; Humans; Indans; Muscarinic Antagonists; Pulmonary Disease, Chronic Obstructive; Quinolones; Severity of Illness Index
PubMed: 28389258
DOI: 10.1016/j.pupt.2017.04.002 -
Primary Care Respiratory Journal :... Dec 2011Effective bronchodilation is an important part of the management of patients with chronic obstructive pulmonary disease (COPD) and can improve breathlessness and ability... (Review)
Review
Effective bronchodilation is an important part of the management of patients with chronic obstructive pulmonary disease (COPD) and can improve breathlessness and ability to undertake physical activities. Indacaterol is a new once-daily, long-acting inhaled bronchodilator for COPD. We review here the efficacy of indacaterol as a bronchodilator, including its impact upon symptoms and health status. The evidence reviewed comprises four placebo-controlled clinical studies of indacaterol treatment, three of which included treatment arms with one of the other long-acting inhaled bronchodilators (once-daily tiotropium or twice-daily salmeterol or formoterol), in 4,833 patients with moderate-to-severe COPD. Indacaterol had a bronchodilator effect significantly greater than formoterol and salmeterol, and similar to tiotropium. Its effect on symptoms and health status was similar or significantly greater than the other bronchodilators. The safety profile was similar to placebo. Once-daily indacaterol is an effective and beneficial maintenance bronchodilator treatment for patients with moderate-to-severe COPD.
Topics: Aged; Albuterol; Bronchodilator Agents; Clinical Trials as Topic; Female; Humans; Indans; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Quinolones; Randomized Controlled Trials as Topic; Severity of Illness Index
PubMed: 21785813
DOI: 10.4104/pcrj.2011.00066 -
Jornal Brasileiro de Pneumologia :... 2015Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the... (Review)
Review
Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients.
Topics: Administration, Inhalation; Bronchodilator Agents; Drug Delivery Systems; Female; Humans; Lung; Male; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive; Respiration, Artificial
PubMed: 26578139
DOI: 10.1590/S1806-37132015000000035 -
Environmental Science and Pollution... Sep 2022Asthma is a chronic inflammatory disease primarily characterized by inflammation and reversible bronchoconstriction. It is currently one of the leading causes of... (Review)
Review
Asthma is a chronic inflammatory disease primarily characterized by inflammation and reversible bronchoconstriction. It is currently one of the leading causes of morbidity and mortality in the world. Oxidative stress further complicates the pathology of the disease. The current treatment strategies for asthma mainly involve the use of anti-inflammatory agents and bronchodilators. However, long-term usage of such medications is associated with severe adverse effects and complications. Hence, there is an urgent need to develop newer, novel, and safe treatment modalities for the management of asthma. This has therefore prompted further investigations and detailed research to identify and develop novel therapeutic interventions from potent untapped resources. This review focuses on the significance of oxidative stressors that are primarily derived from both mitochondrial and non-mitochondrial sources in initiating the clinical features of asthma. The review also discusses the biological scavenging system of the body and factors that may lead to its malfunction which could result in altered states. Furthermore, the review provides a detailed insight into the therapeutic role of nutraceuticals as an effective strategy to attenuate the deleterious effects of oxidative stress and may be used in the mitigation of the cardinal features of bronchial asthma.
Topics: Asthma; Bronchodilator Agents; Dietary Supplements; Humans; Oxidation-Reduction; Oxidative Stress
PubMed: 35796922
DOI: 10.1007/s11356-022-21454-w