Practice ABC of chronic obstructive pulmonary disease

Future treatments

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7561.246 (Published 27 July 2006) Cite this as: BMJ 2006;333:246
  1. Peter J Barnes, professor of respiratory medicine
  1. 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.

    Additive effects of once daily formoterol and tiotropium on forced expiratory volume in 1 second (FEV1) in patients with severe COPD after six weeks' treatment

    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.

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    Problems encountered in developing new drugs for treating COPD

    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.

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    Current and future long acting bronchodilators for treating COPD

    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). …

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