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Boylan PM, Abdalla M, Bissell B, Malesker MA, Santibañez M, Smith Z. Theophylline for the management of respiratory disorders in adults in the 21st century: A scoping review from the American College of Clinical Pharmacy Pulmonary Practice and Research Network. Pharmacotherapy 2023; 43:963-990. [PMID: 37423768 DOI: 10.1002/phar.2843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 07/11/2023]
Abstract
Theophylline is an oral methylxanthine bronchodilator recommended as alternate therapy for the treatment of asthma and chronic obstructive pulmonary disease (COPD). However, it is not generally recommended for the treatment of other respiratory disorders such as obstructive sleep apnea (OSA) or hypoxia. Most clinical practice guidelines rely on evidence published prior to the year 2000 to make these recommendations. This scoping review aimed to gather and characterize evidence describing theophylline for the management of respiratory disorders in adults between January 1, 2000 and December 31, 2020. Databases searched included Ovid MEDLINE, Embase, CINAHL Complete, Scopus, and International Pharmaceutical Abstracts. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Studies were included if they were published in English, theophylline was used for any respiratory disorder, and the study outcomes were disease- or patient-oriented. After removal of duplicates, 841 studies were screened and 55 studies were included. Results aligned with current clinical guideline recommendations relegating theophylline as an alternative therapy for the treatment of respiratory disorders, in favor of inhaled corticosteroids and inhaled bronchodilators. This scoping review identified the need for future research including: theophylline versus other medications deemed alternative therapies for asthma and COPD, meta-analyses of low-dose theophylline, and studies evaluating evidence-based patient-oriented outcomes for OSA, hypoxia, ventilator-induced diaphragmatic dysfunction, and spinal cord injury-related pulmonary function.
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Affiliation(s)
- Paul M Boylan
- Department of Pharmacy: Clinical and Administrative Sciences, The University of Oklahoma Health Sciences Center, College of Pharmacy, Oklahoma City, Oklahoma, USA
| | - Maha Abdalla
- Department of Pharmaceutical Sciences, South College, School of Pharmacy, Knoxville, Tennessee, USA
| | - Brittany Bissell
- Department of Pharmacy Practice and Science, The University of Kentucky, College of Pharmacy, Lexington, Kentucky, USA
| | - Mark A Malesker
- Department of Pharmacy Practice, Creighton University, School of Pharmacy and Health Professions, Omaha, Nebraska, USA
| | - Melissa Santibañez
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, USA
| | - Zachary Smith
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA
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2
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Shahzadi I, Zahoor AF, Rasul A, Rasool N, Raza Z, Faisal S, Parveen B, Kamal S, Zia‐ur‐Rehman M, Zahid FM. Synthesis, anticancer, and computational studies of 1, 3,
4‐oxadiazole‐purine
derivatives. J Heterocycl Chem 2020. [DOI: 10.1002/jhet.3987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Irum Shahzadi
- Department of ChemistryGovernment College University Faisalabad Faisalabad Pakistan
| | - Ameer F. Zahoor
- Department of ChemistryGovernment College University Faisalabad Faisalabad Pakistan
| | - Azhar Rasul
- Department of ZoologyGovernment College University Faisalabad Faisalabad Pakistan
| | - Nasir Rasool
- Department of ChemistryGovernment College University Faisalabad Faisalabad Pakistan
| | - Zohaib Raza
- Department of PharmacologyGovernment College University Faisalabad Faisalabad Pakistan
| | - Shahla Faisal
- Department of StatisticsGovernment College University Faisalabad Faisalabad Pakistan
| | - Bushra Parveen
- Department of ChemistryGovernment College University Faisalabad Faisalabad Pakistan
| | - Shagufta Kamal
- Department of BiochemistryGovernment College University Faisalabad Faisalabad Pakistan
| | | | - Faisal M. Zahid
- Department of StatisticsGovernment College University Faisalabad Faisalabad Pakistan
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3
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Huang K, Guo Y, Kang J, An L, Zheng Z, Ma L, Peng L, Wang H, Su R, Itoh Y, Wang C. The efficacy of adding budesonide/formoterol to ipratropium plus theophylline in managing severe chronic obstructive pulmonary disease: an open-label, randomized study in China. Ther Adv Respir Dis 2019; 13:1753466619853500. [PMID: 31240995 PMCID: PMC6595664 DOI: 10.1177/1753466619853500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Patients diagnosed with chronic obstructive pulmonary disease (COPD) in China
are commonly prescribed ipratropium plus theophylline (I+T) therapy. Studies
have shown that an inhaled corticosteroid (ICS)/long-acting
β2-agonist (LABA) combination is also efficacious in reducing
symptoms and exacerbations. This study evaluated the efficacy and
tolerability of adding budesonide/formoterol (BUD/FORM) to I+T in Chinese
patients with severe COPD. Methods: A randomized, parallel-group, open-label, multicenter phase IV study
(Clinical Trials.gov identifier: NCT01415518) was conducted in China.
Patients received either BUD/FORM (160/4.5 µg; two inhalations twice daily
[bid] via Turbuhaler®) + I (20 µg per inhalation, two inhalations
four times daily) + T (100 mg bid) or I+T alone for 12 weeks. The primary
efficacy variable was change from baseline in predose forced expiratory
volume in 1 s (FEV1). Results: A total of 584 patients were randomized equally between treatment groups. At
the end of the study, the BUD/FORM plus I+T group displayed significant
improvements in predose FEV1 versus the I+T group (between-group
difference 6.9%; 95% confidence interval [CI]: 4.3, 9.6; p
< 0.0001). Forced vital capacity, inspiratory capacity, peak expiratory
flow and health-related quality of life (HRQoL) scores were significantly
improved (all p < 0.0001) and exacerbation frequency was
reduced (43.5% reduction; rate ratio 0.565, 95% CI 0.325, 0.981;
p = 0.0425) with BUD/FORM plus I+T versus I+T
alone. Conclusion: Patients with severe COPD in China treated with BUD/FORM plus I+T showed
significant improvements in lung function and HRQoL and a reduction in
exacerbations compared with I+T alone. Both treatments were well tolerated
and no safety concerns were noted. The reviews of this paper are available via the supplemental material
section.
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Affiliation(s)
- Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, China.,Beijing Institute of Respiratory Medicine, China
| | - Yanfei Guo
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Ministry of Health, Dongdan, China
| | - Jian Kang
- The First Hospital of China Medical University, Heping, Shenyang, China
| | - Li An
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, China
| | - Zeguang Zheng
- The First Affiliated Hospital of Guangzhou Medical University, Yuexiu, China
| | - Lijun Ma
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Liping Peng
- Jilin University First Hospital, Changchun, China
| | - Hongyang Wang
- Hebei United University Affiliated Hospital, Tangshan, China
| | - Rong Su
- Global Medicines Development, AstraZeneca, Shanghai, China
| | | | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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4
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Pharmacological Therapy of COPD. Chest 2018; 154:1404-1415. [DOI: 10.1016/j.chest.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022] Open
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Gobouri AA. Organic selenium compounds: Synthesis and reactions of some new 7-alkyl-8-selenotheophyllines. PHOSPHORUS SULFUR 2016. [DOI: 10.1080/10426507.2015.1119137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Adil A. Gobouri
- Department of Chemistry, Faculty of Science, Taif University, Taif, Saudi Arabia
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Aswini KK, Vinu Mohan AM, Biju VM. Molecularly imprinted poly(4-amino-5-hydroxy-2,7-naphthalenedisulfonic acid) modified glassy carbon electrode as an electrochemical theophylline sensor. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 65:116-25. [PMID: 27157734 DOI: 10.1016/j.msec.2016.03.098] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/09/2016] [Accepted: 03/29/2016] [Indexed: 11/26/2022]
Abstract
Theophylline is an inexpensive drug employed in asthma and chronic obstructive pulmonary disorder medications and is toxic at higher concentration. The development of a molecularly imprinted polymer based theophylline electrochemical sensor on glassy carbon electrode by the electropolymerization of 4-amino-5-hydroxy-2,7-naphthalenedisulfonic acid is being discussed in this work. The MIP modification enhances the theophylline recognition ability and the electron transfer kinetics of the bare electrode. The parameters, controlling the performance of the imprinted polymer based sensor, like number of electropolymerization cycles, composition of the pre-polymerization mixture, pH and immersion time were investigated and optimized. The interaction energy and the most stable conformation of the template-monomer complex in the pre-polymerization mixture were determined computationally using ab initio calculations based on density functional theory. The amperometric measurements showed that the developed sensor has a method detection limit of 0.32μM for the dynamic range of 0.4 to 17μM, at optimized conditions. The transducer possesses appreciable selectivity in the presence of structurally similar interferents such as theobromine, caffeine and doxofylline. The developed sensor showed remarkable stability and reproducibility and was also successfully employed in theophylline detection from commercially available tablets.
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Affiliation(s)
- K K Aswini
- Department of Chemistry, National Institute of Technology, Tiruchirappalli, TamilNadu 620 015, India.
| | - A M Vinu Mohan
- Department of Chemistry, National Institute of Technology, Tiruchirappalli, TamilNadu 620 015, India
| | - V M Biju
- Department of Chemistry, National Institute of Technology, Tiruchirappalli, TamilNadu 620 015, India.
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Rennard S, Fogarty C, Reisner C, Fernandez C, Fischer T, Golden M, Rose ES, Darken P, Tardie G, Orevillo C. Randomized study of the safety, pharmacokinetics, and bronchodilatory efficacy of a proprietary glycopyrronium metered-dose inhaler in study patients with chronic obstructive pulmonary disease. BMC Pulm Med 2014; 14:118. [PMID: 25027304 PMCID: PMC4124171 DOI: 10.1186/1471-2466-14-118] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/26/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bronchodilator medications are central to the symptomatic management of chronic obstructive pulmonary disease (COPD). Metered-dose inhalers (MDIs) are the most commonly used devices to deliver treatment to patients with COPD and asthma, comprising approximately 70% of bronchodilator prescriptions. Proprietary porous-particle technology permits the formulation of long-acting muscarinic antagonists, long-acting β2-agonists, and a combination of both in hydrofluoroalkane (HFA) MDIs, providing a solution to formulation challenges inherent to the development of HFA MDIs, which have contributed to the development of dry-powder inhalers. METHODS In this randomized, double-blind, 4-period, 6-treatment, placebo- and active-controlled, multicenter, crossover study, 4 ascending single doses of a proprietary glycopyrronium (GP) MDI were evaluated compared with Placebo MDI and open-label tiotropium (TIO) in study patients with COPD. Thirty-three study patients were enrolled and received single-dose administration of 4 of the 6 treatments (Placebo MDI, TIO 18 μg, or GP MDI at 14.4, 28.8, 57.6, and 115.2 μg ex-actuator) with an interval of 1 to 3 weeks between doses. The primary efficacy endpoint was peak change in forced expiratory volume in 1 second (FEV1). RESULTS All 4 doses of GP MDI showed statistically superior efficacy compared with Placebo MDI for peak FEV1 (differences of 146 to 248 mL; P<.001), with a clear dose ordering of the response. Statistically significant differences compared with Placebo MDI were noted at almost all doses for the secondary FEV1 parameters (P ≤ .049) except 24-hour trough FEV1 at 28.8 μg. All doses were safe and well tolerated in this study; the most frequently reported adverse event was dry mouth (0-14.3% across doses; 9.5% for Placebo MDI, and 9.1% for TIO). CONCLUSIONS This study demonstrated superior bronchodilatory efficacy of GP MDI compared with Placebo MDI at all doses tested, and no serious adverse events were reported. This study supports the further evaluation of GP MDI in study patients with COPD. In addition, these findings indicate that the correct dosage of glycopyrronium is no more than 115.2 μg total daily dose, or 57.6 μg twice daily based on comparisons with the active comparator. TRIAL REGISTRATION This clinical trial was registered on ClinicalTrials.gov, Identifier: NCT00871182.
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Affiliation(s)
- Stephen Rennard
- University of Nebraska Medical Center, Physicians Internal Medicine at the Durham Outsubject Center, Omaha, NE, USA
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8
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Gupta D, Agarwal R, Aggarwal AN, Maturu VN, Dhooria S, Prasad KT, Sehgal IS, Yenge LB, Jindal A, Singh N, Ghoshal AG, Khilnani GC, Samaria JK, Gaur SN, Behera D. Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations. Lung India 2013; 30:228-67. [PMID: 24049265 PMCID: PMC3775210 DOI: 10.4103/0970-2113.116248] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.
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Affiliation(s)
- Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - V. N. Maturu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K. T. Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul S. Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lakshmikant B. Yenge
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A. G. Ghoshal
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - G. C. Khilnani
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - J. K. Samaria
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - S. N. Gaur
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - D. Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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9
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Vehring R, Lechuga-Ballesteros D, Joshi V, Noga B, Dwivedi SK. Cosuspensions of microcrystals and engineered microparticles for uniform and efficient delivery of respiratory therapeutics from pressurized metered dose inhalers. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2012; 28:15015-15023. [PMID: 22985189 DOI: 10.1021/la302281n] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Engineered porous phospholipid microparticles with aerodynamic diameters in the respirable range of 1-2 μm were cosuspended in 1,1,1,2-tetrafluoroethane, a propellant, with microcrystals of glycopyrrolate, formoterol fumarate dihydrate, or Mometasone furoate-three drugs with different solubilities in the propellant, and different physical, chemical, and pharmacological attributes. The drug microcrystals were added individually, in pairs, or all three together to prepare different cosuspensions, contained in a pressurized metered dose inhaler (pMDI). The drug microcrystals irreversibly associated with the porous particles, and the resultant cosuspensions possessed greatly improved suspension stability compared with suspensions of drug microcrystals alone. In general, all cosuspensions showed efficient dose delivery of the drugs, with fine particle fractions of more than 60% for a wide range of doses, including those as low as 300 ng per inhaler actuation. In the cosuspension pMDIs, comparable fine particle fractions were delivered for all tested drugs, whether or not they were emitted from an inhaler containing one, two, or three drugs. We demonstrate that the cosuspension approach solves at least three long-standing problems in the clinical development of pMDI-based products: (1) dose and drug dependent delivery efficiency, (2) inability to formulate dose strengths below 1 μg to fully explore drug efficacy and safety, and (3) combination suspensions delivering a different fine particle fraction than individual drug suspensions.
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Affiliation(s)
- Reinhard Vehring
- Pearl Therapeutics, Inc., Redwood City, California 94063, United States
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10
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Voduc N, Alvarez GG, Amjadi K, Tessier C, Sabri E, Aaron SD. Effect of theophylline on exercise capacity in COPD patients treated with combination long-acting bronchodilator therapy: a pilot study. Int J Chron Obstruct Pulmon Dis 2012; 7:245-52. [PMID: 22563244 PMCID: PMC3340114 DOI: 10.2147/copd.s29990] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many patients with chronic obstructive pulmonary disease continue to experience significant functional limitation despite the use of both long-acting anticholinergic and beta-agonist inhalers. Theophylline is a widely available medication which may further improve lung function and exercise performance. Previous studies evaluating the effects of theophylline on exercise capacity in chronic obstructive pulmonary disease (COPD) have demonstrated heterogeneous results. METHODS We performed a randomized placebo-controlled double-blind pilot study assessing the effects of theophylline on constant load exercise duration and lung function, involving 24 COPD patients already treated with long-acting inhaled beta-agonist and long-acting anti-cholinergic bronchodilator therapy. RESULTS Analyzable data was available in 10 of 12 subjects in the treatment arm and 11 of 12 subjects in the control arm. Theophylline was associated with a 26.1% (95% confidence interval [CI]: -17.3-69.5) improvement in exercise duration compared to placebo. Four of 10 treated patients demonstrated an improvement in exercise duration exceeding the minimum clinically important difference of 33%, compared to 1 of 11 controls (P = 0.15). Furthermore, peak ventilation was reduced by 11.1%, (95% CI: 0.77-21.5) which may suggest improvements in gas exchange. There were no significant observed differences in resting lung function nor measures of dyspnea between the two treatment groups. CONCLUSIONS Our study demonstrated a trend, but not a statistically significant improvement in exercise duration and a reduction in peak ventilation with theophylline. Based on the observed mean differences and standard deviations in this pilot study, a randomized controlled trial would require 45 subjects in each arm to detect a significant change in exercise duration.
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Affiliation(s)
- Nha Voduc
- University of Ottawa, Division of Respirology, Ottawa, ON, Canada.
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Cazzola M, Tashkin DP. Combination of Formoterol and Tiotropium in the Treatment of COPD: Effects on Lung Function. COPD 2009; 6:404-15. [DOI: 10.1080/15412550903156333] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rossi A, Khirani S, Cazzola M. Long-acting beta2-agonists (LABA) in chronic obstructive pulmonary disease: efficacy and safety. Int J Chron Obstruct Pulmon Dis 2009; 3:521-9. [PMID: 19281071 PMCID: PMC2650610 DOI: 10.2147/copd.s1353] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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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Affiliation(s)
- Andrea Rossi
- Unit of Respiratory Diseases, Hospital of Bergamo, Bergamo, Italy.
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Abstract
The treatment objectives for chronic obstructive pulmonary disease (COPD) include relieving symptoms such as dyspnea and cough, slowing the accelerated decline in lung function, decreasing exacerbations, and improving quality of life. All major guidelines for COPD management recommend beginning treatment with bronchodilators. There are several classes of bronchodilators, including beta-agonists, anticholinergics, and phosphodiesterase inhibitors, each with a specific mechanism of action. The overall approach to managing stable COPD involves a stepwise increase in treatment. Because of the progressive nature of emphysema, such an approach often involves combining bronchodilators from different pharmacologic classes. This review focuses on the pharmacologic properties of various bronchodilators and on recent studies that have examined combination therapy as a means to optimize treatment.
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Kawayama T, Hoshino T, Ichiki M, Tsuda T, Kinoshita M, Takata S, Koga T, Iwanaga T, Aizawa H. Effect of add-on therapy of tiotropium in COPD treated with theophylline. Int J Chron Obstruct Pulmon Dis 2008; 3:137-47. [PMID: 18488437 PMCID: PMC2528215 DOI: 10.2147/copd.s2103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although combination therapy with bronchodilators is recommended for chronic obstructive pulmonary disease (COPD), there is insufficient evidence for the efficacy of some combinations of long-acting bronchodilators. OBJECTIVE We investigated the effects of a combination therapy with tiotropium and theophylline in COPD patients. METHODS In a 12-week, open-labeled, parallel-group randomized study, pulmonary functions and dyspnea scores were compared between the combination and theophylline alone therapy at baseline, and 4 and 8 weeks after randomization in COPD. RESULTS Sixty-one COPD patients completed the trial (31 combination therapy, 30 theophylline alone; mean age 70 years; 58 males; mean dyspnea score 2.0 and forced expiratory volume in one second (FEV1) 1.5 L [62.5% predicted]). FEV1 in the combination group, but not in the theophylline alone, was significantly increased at 4 (1.56 +/- 0.13 L, p < 0.001) and 8 weeks (1.60 +/- 0.13 L, p < 0.001) from the baseline (1.40 +/- 0.12 L). In the combination group, but not the theophylline alone group, the dyspnea score was significantly improved after 4 (p < 0.01) and 8 weeks (p <0.05) compared with baseline. In 17 patients who did not receive theophylline at screening, treatment with 4 or 8 weeks of theophylline alone did not improve dyspnea score or FEV1. CONCLUSION Addition of tiotropium therapy to theophylline treatment can improve dyspnea and pulmonary function in COPD. Although this study did not assess whether there was any benefit of adding theophylline to patients treated with tiotropium, tiotropium can be a useful addition in COPD already treated with theophylline.
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Affiliation(s)
- Tomotaka Kawayama
- Department of Medicine, Kurume University School of Medicine, Kurume, Japan
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15
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Cazzola M, Matera MG. Novel long-acting bronchodilators for COPD and asthma. Br J Pharmacol 2008; 155:291-9. [PMID: 18604231 DOI: 10.1038/bjp.2008.284] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An important step in simplifying asthma and chronic obstructive pulmonary disease (COPD) management and improving adherence with prescribed therapy is to reduce the dose frequency to the minimum necessary to maintain disease control. Therefore, the incorporation of once-daily dose administration is an important strategy to improve adherence and is a regimen preferred by most patients, which may also lead to enhancement of compliance, and may have advantages leading to improved overall clinical outcomes. Once-daily beta2-agonists or ultra long-acting beta2-agonists (LABAs) such as carmoterol, indacaterol, GSK-159797, GSK-597901, GSK-159802, GSK-642444 and GSK-678007 are under development for the treatment of asthma and COPD. Also some new long-acting antimuscarinic agents (LAMAs) such as aclidinium, LAS-35201, GSK656398, GSK233705, NVA-237 (glycopyrrolate) and OrM3 are under development. In any case, the current opinion is that it will be advantageous to develop inhalers containing combination of several classes of long-acting bronchodilator drugs in an attempt to simplify treatment regimens as much as possible. Consequently, several options for once-daily dual-action ultra LABA+LAMA combination products are currently being evaluated. A different approach is to have a dimer molecule in which both pharmacologies are present (these molecules are known as M3 antagonist-beta2 agonist (MABA) bronchodilators). The advent of a successful MABA product will revolutionize the field and open the door for a new range of combination products.
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Affiliation(s)
- M Cazzola
- Unit of Respiratory Diseases, Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy.
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Tashkin DP, Littner M, Andrews CP, Tomlinson L, Rinehart M, Denis-Mize K. Concomitant treatment with nebulized formoterol and tiotropium in subjects with COPD: a placebo-controlled trial. Respir Med 2008; 102:479-87. [PMID: 18258423 DOI: 10.1016/j.rmed.2007.12.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/18/2007] [Accepted: 12/19/2007] [Indexed: 11/17/2022]
Abstract
Adding a long-acting beta(2)-agonist (LABA) by dry powder inhaler (DPI) to tiotropium provides significantly increased and sustained bronchodilation in chronic obstructive pulmonary disease (COPD) patients over either product alone. To demonstrate similar benefits with a nebulized LABA, a placebo-controlled trial was conducted to evaluate the efficacy and safety of formoterol fumarate inhalation solution in subjects receiving tiotropium as a maintenance treatment for COPD. After a 7-14-day screening period using tiotropium 18 microg once daily, subjects with diagnosed COPD (> or = 25% to <65% predicted FEV(1)) were randomized to receive 20 microg formoterol fumarate inhalation solution twice daily for nebulization plus tiotropium (FFIS/TIO) or nebulized placebo twice daily plus tiotropium (PLA/TIO) for 6 weeks. Efficacy was assessed with spirometry at each visit (Day 1, Week 1, 3, 6), the transition dyspnea index (TDI), and St. George's Respiratory Questionnaire (SGRQ). Baseline characteristics were comparable, including mean FEV(1)% predicted. At Week 6, FEV(1) AUC(0-3) was 1.52 L for FFIS/TIO-treated subjects vs. 1.34 L for PLA/TIO-treated subjects (p<0.0001). The mean TDI scores in the FFIS/TIO and PLA/TIO groups were 2.30 and 0.16, respectively (p=0.0002). SGRQ did not change significantly with 6 weeks treatment, with the exception of FFIS/TIO improvements in symptom score vs. PLA/TIO (p=0.04). More PLA/TIO- than FFIS/TIO-treated subjects experienced AEs (39.7% vs. 22.9%), COPD exacerbations (7.9% vs. 4.5%), and serious AEs (3.2% vs. 1.5%). Nebulized formoterol fumarate in combination with tiotropium provided statistically and clinically significant improvements in bronchodilation and symptom control over tiotropium alone and demonstrated good tolerability.
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Affiliation(s)
- Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Baraldi PG, Tabrizi MA, Gessi S, Borea PA. Adenosine Receptor Antagonists: Translating Medicinal Chemistry and Pharmacology into Clinical Utility. Chem Rev 2008; 108:238-63. [DOI: 10.1021/cr0682195] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Pier Giovanni Baraldi
- Departments of Pharmaceutical Sciences and Clinical and Experimental Medicine, Pharmacology Unit and Interdisciplinary Center for the Study of Inflammation, University of Ferrara, Italy
| | - Mojgan Aghazadeh Tabrizi
- Departments of Pharmaceutical Sciences and Clinical and Experimental Medicine, Pharmacology Unit and Interdisciplinary Center for the Study of Inflammation, University of Ferrara, Italy
| | - Stefania Gessi
- Departments of Pharmaceutical Sciences and Clinical and Experimental Medicine, Pharmacology Unit and Interdisciplinary Center for the Study of Inflammation, University of Ferrara, Italy
| | - Pier Andrea Borea
- Departments of Pharmaceutical Sciences and Clinical and Experimental Medicine, Pharmacology Unit and Interdisciplinary Center for the Study of Inflammation, University of Ferrara, Italy
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