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.

New bronchodilators

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). …