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Abstract
Clinical trials with new drugs for chronic obstructive pulmonary disease (COPD) have been performed. Viruses exacerbate COPD and bacteria may play a part in severe COPD; therefore, antibiotic and antiviral approaches have a sound rationale. Antiinflammatory approaches have been studied. Advances in understanding the molecular basis of other processes have resulted in novel drugs to target reactive oxidant species, mucus, proteases, fibrosis, cachexia, and muscle wasting, and accelerated aging. Studies with monoclonal antibodies have been disappointing, highlighting the tendency for infections and malignancies during treatment. Promising future directions are lung regeneration with retinoids and stem cells.
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Affiliation(s)
- Clare L Ross
- Imperial Clinical Respiratory Research Unit (ICRRU), Biomedical Research Centre (BMRC), Centre for Respiratory Infection (CRI), National Heart and Lung Institute (NHLI), St Mary's Hospital, Imperial College, Praed Street, Paddington, London W2 INY, UK
| | - Trevor T Hansel
- Imperial Clinical Respiratory Research Unit (ICRRU), Biomedical Research Centre (BMRC), Centre for Respiratory Infection (CRI), National Heart and Lung Institute (NHLI), St Mary's Hospital, Imperial College, Praed Street, Paddington, London W2 INY, UK.
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Mui TS, Man SP, Sin DD. Developments in drugs for the treatment of chronic obstructive pulmonary disease. Expert Rev Clin Immunol 2010; 4:365-77. [PMID: 20476926 DOI: 10.1586/1744666x.4.3.365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) affects more than 600 million adults worldwide and accounts for 3 million deaths annually. Approximately 50% of the cases are directly attributable to cigarette smoking; the rest are accounted for by different risk factors, including childhood infections, genetic defects, environmental pollution and biomass exposure. The mainstay of current drug treatment is bronchodilation. Anti-inflammatory drugs are reserved for patients with moderate-to-severe disease. In this article, we will review the current paradigm of COPD pathogenesis and discuss some promising molecular targets that may be modified in the future to improve health outcomes of patients with COPD.
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Affiliation(s)
- Tammy Sy Mui
- The Providence Heart and Lung Center, The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St Paul's Hospital & the Department of Medicine (Respiratory Division), The University of British Columbia, Vancouver, BC, Canada.
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Ciarka A, Vincent JL, van de Borne P. The effects of dopamine on the respiratory system: Friend or foe? Pulm Pharmacol Ther 2007; 20:607-15. [PMID: 17150392 DOI: 10.1016/j.pupt.2006.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Revised: 10/15/2006] [Accepted: 10/16/2006] [Indexed: 01/11/2023]
Abstract
Dopamine (DA) is an immediate precursor of noradrenaline that has stimulatory or inhibitory effects on a variety of adrenergic receptors. DA is primarily used in the management of circulatory shock for its combined vasopressor and inotropic effects, but it may also exert significant effects on the respiratory system Although the respiratory effects of intravenous DA attract less attention than its hemodynamic effects, there is evidence that DA affects ventilation, pulmonary circulation, bronchial diameter, neuromodulation of sensory pulmonary nerves and lung water clearance. Through these complex mechanisms, DA may exert beneficial as well as detrimental effects on respiration. DA may have beneficial effects on the respiratory system by decreasing oedema formation and improving respiratory muscle function, but can also have deleterious effects, by inhibiting ventilation. Hence, DA may be beneficial in lung oedema, but harmful in cases of difficult weaning from mechanical ventilation. DA should be used with caution in patients with heart failure during weaning from mechanical respiration; however, critically ill patients with chronic obstructive pulmonary disease (COPD) do not show this negative effect of DA on ventilatory drive.
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Affiliation(s)
- Agnieszka Ciarka
- Cardiology Department, Erasme University Hospital, Free University of Brussels, Belgium.
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Giles ME, Thomson C, Eyley SC, Cole AJ, Goodwin CJ, Hurved PA, Morlin AJG, Tornos J, Atkinson S, Just C, Dean JC, Singleton JT, Longton AJ, Woodland I, Teasdale A, Gregertsen B, Else H, Athwal MS, Tatterton S, Knott JM, Thompson N, Smith SJ. Development of a Manufacturing Process for Sibenadet Hydrochloride, the Active Ingredient of Viozan. Org Process Res Dev 2004. [DOI: 10.1021/op049953y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Melvyn E. Giles
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Colin Thomson
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Stephen C. Eyley
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Andrea J. Cole
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Christopher J. Goodwin
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Paul A. Hurved
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Andrew J. G. Morlin
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - James Tornos
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Stéphanie Atkinson
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Cecelia Just
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Janet C. Dean
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - John T. Singleton
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Andrew J. Longton
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Ian Woodland
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Andrew Teasdale
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Björn Gregertsen
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Howard Else
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Mandip S. Athwal
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Stephen Tatterton
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Jason M. Knott
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Nicola Thompson
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
| | - Stephen J. Smith
- AstraZeneca R & D Charnwood, Process R & D, Bakewell Road, Loughborough, Leicestershire LE11 5RH, United Kingdom
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O'Brien JA, Ward AJ, Jones MKC, McMillan C, Lordan N. Utilization of health care services by patients with chronic obstructive pulmonary disease. Respir Med 2003; 97 Suppl A:S53-8. [PMID: 12564611 DOI: 10.1016/s0954-6111(03)80015-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In order to identify healthcare resource use patterns associated with chronic obstructive pulmonary disease (COPD), resource utilization (RU) data collection was integrated into a randomized, double-blind placebo-controlled study of Viozan (sibenadet HCl). This study enrolled patients with symptomatic, smoking-related COPD, randomized to receive sibenadet or placebo for a 52-week treatment period. A questionnaire establishing typical pre-trial, COPD-related RU was completed by each patient. Subsequent data were collected by means of an Interactive Voice Response System (IVRS) at 30-day intervals (14 time points) during the study and in the follow-up period. The IVRS system facilitated data collection and minimized inconvenience to the patient. Compliance with the requirement to record details of the healthcare services during the year-long study was high. No overall trend for lower RU was associated with sibenadet therapy, which correlates with the lack of sustained clinical effect seen in studies conducted concurrently. These data do, however, provide valuable information on RU associated with COPD and insights into adjustments associated with changes in disease course. Physicians were seen to be the most common source of care for patients with COPD and more of the patients with severe COPD (stage III) than mild (stage I) were seen to utilize the most expensive resources (e.g. inpatient hospital care). For those patients who experienced an exacerbation during the trial (irrespective of treatment group), resource use was increased during the periods when an exacerbation was reported when compared with the periods before or after an exacerbation. The proportion of cases attending the physician doubled and with a trip to the Emergency Room (ER) increased approximately ninefold during the reporting period in which the exacerbation occurred compared with the previous month. This study has shown that use of an IVRS, even in elderly patients, is an effective means of gathering RU data over long periods. The study findings suggest that the advent of effective therapeutic interventions, particularly any with the ability to minimize exacerbations and limit disease progression, could impact on the health care services used and potentially reduce associated costs.
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Affiliation(s)
- J A O'Brien
- Caro Research Institute, Concord, MA 01742, USA.
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