Future treatmentsBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7561.246 (Published 27 July 2006) Cite this as: BMJ 2006;333:246
- Peter J Barnes, professor of respiratory medicine
- National Heart and Lung Institute, Imperial College London.
Current treatment used in the management of chronic obstructive pulmonary disease (COPD) is often poorly effective and fails to halt the relentless decline in lung function that leads to increasing symptoms, disability, and exacerbations. This has stimulated clinicians, scientists, and drug companies to seek more effective ways to control the underlying disease process.
The challenge of drug development
Only recently has there been much research into the molecular and cell biology of COPD in order to identify new therapeutic targets. There are several reasons why drug development in COPD is fraught with difficultly, but significant progress is being been made, and several new therapeutic strategies are now in the preclinical and clinical stages of development.
The mainstay of current drug therapy in COPD consists of long acting bronchodilators—β2 agonists (salmeterol and formoterol) and anticholinergics (tiotropium). They are the preferred first line treatment for symptomatic patients with established disease. Several new long acting anticholinergics and once daily (“ultra-long acting”) β2 agonists are in development for treating COPD. Although novel classes of bronchodilators, such as potassium channel openers, have been investigated, these have proved to be less effective than established bronchodilators and have more adverse effects.
Fixed combination inhalers—which contain an inhaled corticosteroid plus long acting β2 agonist—are now commonly prescribed for patients with COPD. Both salmeterol-fluticasone (Seretide) and formoterol-budesonide (Symbicort) are more effective than their separate constituents as monotherapy and are indicated in patients with moderate to severe airflow obstruction (forced expiratory volume in one second (FEV1) < 50% predicted) who have frequent exacerbations (> 2 per year). …