1
|
Bruning R, Dykes H, Jones TW, Wayne NB, Sikora Newsome A. Beta-Adrenergic Blockade in Critical Illness. Front Pharmacol 2021; 12:735841. [PMID: 34721025 PMCID: PMC8554196 DOI: 10.3389/fphar.2021.735841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/27/2021] [Indexed: 12/31/2022] Open
Abstract
Catecholamine upregulation is a core pathophysiological feature in critical illness. Sustained catecholamine β-adrenergic induction produces adverse effects relevant to critical illness management. β-blockers (βB) have proposed roles in various critically ill disease states, including sepsis, trauma, burns, and cardiac arrest. Mounting evidence suggests βB improve hemodynamic and metabolic parameters culminating in decreased burn healing time, reduced mortality in traumatic brain injury, and improved neurologic outcomes following cardiac arrest. In sepsis, βB appear hemodynamically benign after acute resuscitation and may augment cardiac function. The emergence of ultra-rapid βB provides new territory for βB, and early data suggest significant improvements in mitigating atrial fibrillation in persistently tachycardic septic patients. This review summarizes the evidence regarding the pharmacotherapeutic role of βB on relevant pathophysiology and clinical outcomes in various types of critical illness.
Collapse
Affiliation(s)
- Rebecca Bruning
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, United States
| | - Hannah Dykes
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, United States
| | - Timothy W Jones
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, United States
| | - Nathaniel B Wayne
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, United States
| | - Andrea Sikora Newsome
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, United States
| |
Collapse
|
2
|
Cardet JC, Bulkhi AA, Lockey RF. Nonrespiratory Comorbidities in Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3887-3897. [PMID: 34492402 PMCID: PMC8631133 DOI: 10.1016/j.jaip.2021.08.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022]
Abstract
Asthma is a chronic heterogeneous airway disease. Common comorbid conditions are often disproportionately present in severe asthma. Optimal care of patients with asthma requires the recognition and treatment of these comorbid conditions. This review outlines the pathophysiological mechanisms between nonrespiratory comorbid conditions and asthma and their effect on asthma outcomes. They include: type 2 diabetes mellitus, hypertension, atherosclerotic cardiovascular disease, adrenal and thyroid gland diseases, pregnancy, osteoporosis, adverse effects from medications, and mental health disorders. Studies indicate how poor glycemic control of type 2 diabetes mellitus is associated with not only greater health care utilization but poorer asthma outcomes. Also, a large health care claims database indicates that a substantial proportion of pregnant women have uncontrolled asthma and are prescribed suboptimal controller therapy. Additional data about these nonrespiratory comorbidities and medications known to benefit both nonrespiratory comorbidities and asthma are necessary.
Collapse
Affiliation(s)
- Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
| | - Adeeb A Bulkhi
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla; Department of Internal Medicine, College of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Richard F Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla; Department of Internal Medicine, James A. Haley Veterans' Hospital, Tampa, Fla.
| |
Collapse
|
3
|
Do beta-adrenergic blocking agents increase asthma exacerbation? A network meta-analysis of randomized controlled trials. Sci Rep 2021; 11:452. [PMID: 33432057 PMCID: PMC7801657 DOI: 10.1038/s41598-020-79837-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023] Open
Abstract
Beta-adrenergic blocking agents (abbreviated as beta-blockers) have been used for treating various cardiovascular diseases. However, the potential for asthma exacerbation is one of the major adverse effects of beta-blockers. This study aimed to compare the level of risk for an asthma attack in patients receiving various beta-blockers. We searched for randomized controlled trials (RCTs) of either placebo-controlled or active-controlled design. The current network meta-analysis (NMA) was conducted under a frequentist model. The primary outcome was the incidence of asthmatic attack. A total of 24 RCTs were included. Overall NMA revealed that only oral timolol [risk ratio (RR) = 3.35 (95% confidence interval (CI) 1.04–10.85)] and infusion of propranolol [RR = 10.19 (95% CI 1.29–80.41)] were associated with significantly higher incidences of asthma attack than the placebo, whereas oral celiprolol [RR = 0.39 (95% CI 0.04–4.11)], oral celiprolol and propranolol [RR = 0.46 (95% CI 0.02–11.65)], oral bisoprolol [RR = 0.46 (95% CI 0.02–11.65)], oral atenolol [RR = 0.51 (95% CI 0.20–1.28)], infusion of practolol [RR = 0.80 (95% CI 0.03–25.14)], and infusion of sotalol [RR = 0.91 (95% CI 0.08–10.65)] were associated with relatively lower incidences of asthma attack than the placebo. In participants with a baseline asthma history, in addition to oral timolol and infusion of propranolol, oral labetalol, oxprenolol, propranolol, and metoprolol exhibited significantly higher incidences of asthma attack than did the placebo. In conclusion, oral timolol and infusion of propranolol were associated with a significantly higher risk of developing an asthma attack in patients, especially in those with a baseline asthma history, and should be avoided in patients who present a risk of asthma. Trial registration: PROSPERO CRD42020190540.
Collapse
|
4
|
Dawes RP, Burke KA, Byun DK, Xu Z, Stastka P, Chan L, Brown EB, Madden KS. Chronic Stress Exposure Suppresses Mammary Tumor Growth and Reduces Circulating Exosome TGF-β Content via β-Adrenergic Receptor Signaling in MMTV-PyMT Mice. Breast Cancer (Auckl) 2020; 14:1178223420931511. [PMID: 32595275 PMCID: PMC7301655 DOI: 10.1177/1178223420931511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
Preclinical models of breast cancer have established mechanistic links between psychological stress and cancer progression. However, epidemiological evidence linking stress and cancer is equivocal. We tested the impact of stress exposure in female mice expressing the mouse mammary tumor virus polyoma middle-T antigen (MMTV-PyMT), a spontaneous model of mammary adenocarcinoma that mimics metastatic hormone receptor-positive human breast cancer development. MMTV-PyMT mice were socially isolated at 6 to 7 weeks of age during premalignant hyperplasia. To increase the potency of the stressor, singly housed mice were exposed to acute restraint stress (2 hours per day for 3 consecutive days) at 8 to 9 weeks of age during early carcinoma. Exposure to this dual stressor activated both major stress pathways, the sympathetic nervous system and hypothalamic-pituitary-adrenal axis throughout malignant transformation. Stressor exposure reduced mammary tumor burden in association with increased tumor cleaved caspase-3 expression, indicative of increased cell apoptosis. Stress exposure transiently increased tumor vascular endothelial growth factor and reduced tumor interleukin-6, but no other significant alterations in immune/inflammation-associated chemokines and cytokines or changes in myeloid cell populations were detected in tumors. No stress-induced change in second-harmonic generation-emitting collagen, indicative of a switch to a metastasis-promoting tumor extracellular matrix, was detected. Systemic indicators of slowed tumor progression included reduced myeloid-derived suppressor cell (MDSC) frequency in lung and spleen, and decreased transforming growth factor β (TGF-β) content in circulating exosomes, nanometer-sized particles associated with tumor progression. Chronic β-adrenergic receptor (β-AR) blockade with nadolol abrogated stress-induced alterations in tumor burden and cleaved caspase-3 expression, lung MDSC frequency, and exosomal TGF-β content. Despite the evidence for reduced tumor growth, metastatic lesions in the lung were not altered by stress exposure. Unexpectedly, β-blockade in nonstressed mice increased lung metastatic lesions and splenic MDSC frequency, suggesting that in MMTV-PyMT mice, β-AR activation also inhibits tumor progression in the absence of stress exposure. Together, these results suggest stress exposure can act through β-AR signaling to slow primary tumor growth in MMTV-PyMT mice.
Collapse
Affiliation(s)
- Ryan P Dawes
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
| | - Kathleen A Burke
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Daniel K Byun
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Zhou Xu
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Petr Stastka
- Department of Biology, University of Rochester, Rochester, NY, USA
| | - Leland Chan
- Department of Biology, University of Rochester, Rochester, NY, USA
| | - Edward B Brown
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Kelley S Madden
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| |
Collapse
|
5
|
Abstract
Asthma is a heterogeneous inflammatory disease of the airways that is associated with airway hyperresponsiveness and airflow limitation. Although asthma was once simply categorized as atopic or nonatopic, emerging analyses over the last few decades have revealed a variety of asthma endotypes that are attributed to numerous pathophysiological mechanisms. The classification of asthma by endotype is primarily routed in different profiles of airway inflammation that contribute to bronchoconstriction. Many asthma therapeutics target G protein-coupled receptors (GPCRs), which either enhance bronchodilation or prevent bronchoconstriction. Short-acting and long-acting β 2-agonists are widely used bronchodilators that signal through the activation of the β 2-adrenergic receptor. Short-acting and long-acting antagonists of muscarinic acetylcholine receptors are used to reduce bronchoconstriction by blocking the action of acetylcholine. Leukotriene antagonists that block the signaling of cysteinyl leukotriene receptor 1 are used as an add-on therapy to reduce bronchoconstriction and inflammation induced by cysteinyl leukotrienes. A number of GPCR-targeting asthma drug candidates are also in different stages of development. Among them, antagonists of prostaglandin D2 receptor 2 have advanced into phase III clinical trials. Others, including antagonists of the adenosine A2B receptor and the histamine H4 receptor, are in early stages of clinical investigation. In the past decade, significant research advancements in pharmacology, cell biology, structural biology, and molecular physiology have greatly deepened our understanding of the therapeutic roles of GPCRs in asthma and drug action on these GPCRs. This review summarizes our current understanding of GPCR signaling and pharmacology in the context of asthma treatment. SIGNIFICANCE STATEMENT: Although current treatment methods for asthma are effective for a majority of asthma patients, there are still a large number of patients with poorly controlled asthma who may experience asthma exacerbations. This review summarizes current asthma treatment methods and our understanding of signaling and pharmacology of G protein-coupled receptors (GPCRs) in asthma therapy, and discusses controversies regarding the use of GPCR drugs and new opportunities in developing GPCR-targeting therapeutics for the treatment of asthma.
Collapse
Affiliation(s)
- Stacy Gelhaus Wendell
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (S.G.W., C.Z.); Bioinformatics Institute, Agency for Science, Technology, and Research, Singapore (H.F.); and Department of Biological Sciences, National University of Singapore, and Center for Computational Biology, DUKE-NUS Medical School, Singapore (H.F.)
| | - Hao Fan
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (S.G.W., C.Z.); Bioinformatics Institute, Agency for Science, Technology, and Research, Singapore (H.F.); and Department of Biological Sciences, National University of Singapore, and Center for Computational Biology, DUKE-NUS Medical School, Singapore (H.F.)
| | - Cheng Zhang
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (S.G.W., C.Z.); Bioinformatics Institute, Agency for Science, Technology, and Research, Singapore (H.F.); and Department of Biological Sciences, National University of Singapore, and Center for Computational Biology, DUKE-NUS Medical School, Singapore (H.F.)
| |
Collapse
|
6
|
Tiotiu A, Novakova P, Kowal K, Emelyanov A, Chong-Neto H, Novakova S, Labor M. Beta-blockers in asthma: myth and reality. Expert Rev Respir Med 2019; 13:815-822. [PMID: 31352857 DOI: 10.1080/17476348.2019.1649147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction: Patients with asthma often have important co-morbidities which reduce the likelihood of gaining optimal asthma control. Beta2-blockers are commonly prescribed for the treatment of different clinical indications, including coronary artery disease, cardiac arrhythmia, arterial hypertension, heart failure and glaucoma. Areas covered: The aim of this reviw is to summarize current evidence on the effect of systemic and local β-blockers on asthma outcomes based on their pharmacologic properties,and to help clinicians when prescribing for patients with asthma and co-morbidities. Current data suggest that risk of asthma worsening from systemic and local use of non-selective β-blockers outweighs any potential benefits for their clinical indications. Recent studies confirm that topical and systemic prescription of cardio-selective β-blockers is not associated with a significant increased risk of moderate or severe asthma exacerbations. Expert opinion: Non-selective β-blockers should not be prescribed for the management of comorbidities in patients with asthma while cardio-selective β-blockers, preferably in low doses, may be used when strongly indicated and other therapeutic options are not available. More prospective real-life studies are needed to evaluate the risk of long-term use of β-blockers in patients with asthma.
Collapse
Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy , Nancy , France.,Cardio-respiratory regulation, EA3450 DevAH - Development, Adaptation and Disadvantage. Cardio-respiratory regulations and motor control. University of Lorraine , Nancy , France.,Airways Disease Section, National Heart and Lung Institute, Imperial College London , London , UK
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University Sofia , Sofia , Bulgaria
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine , Bialystok , Poland.,Department of Experimental Allergology and Immunology, Medical University of Bialystok , Bialystok , Poland
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University , Saint-Petersburg , Russian Federation
| | - Herberto Chong-Neto
- Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná , Curitiba , Brazil
| | - Silviya Novakova
- Allergy Unit, Internal Consulting Department, University Hospital "St. George" , Plovdiv , Bulgaria
| | - Marina Labor
- Department of Pulmonology, University Hospital Centre Osijek , Osijek , Croatia.,Medical Faculty Osijek, J.J. Strossmayer University , Osijek , Croatia
| |
Collapse
|
7
|
Kuipers E, Wensing M, De Smet PA, Teichert M. Considerations of prescribers and pharmacists for the use of non-selective β-blockers in asthma and COPD patients: An explorative study. J Eval Clin Pract 2018; 24:396-402. [PMID: 29319215 PMCID: PMC5901013 DOI: 10.1111/jep.12869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Despite recommendations in prevailing guidelines to avoid the use of non-selective (NS) β-blockers in patients with asthma or COPD, on average, 10 patients per community pharmacy receive NS β-blockers monthly. The aim of our study was to identify the reasons of prescribers and pharmacists to treat asthma and COPD patients with NS β-blockers. METHODS Fifty-three community pharmacists in the Netherlands selected patients with actual concurrent use of inhalation medication and NS β-blockers. For at least 5 patients, each pharmacist screened all medication surveillance signals and actions taken at first dispensing. Each pharmacist selected 3 different initial prescribers for a short interview to explore their awareness of the co-morbidity and reasons to apply NS β-blockers. RESULTS Pharmacists identified 827 asthma/COPD patients with actual use of NS β-blockers. From these, 153 NS β-blocker prescribers were selected and interviewed (64 general practitioners, 45 ophthalmologists, 24 cardiologists, and 20 other prescribers). One hundred seven prescribers were aware of the drug-disease interaction of the asthma or COPD co-morbidity when initiating the NS β-blocker, and 46 were not. From these, 40 prescribers did not consider the contraindication to be relevant. For 299 patients, medication surveillance signals and actions at first dispensing were retrieved. Patients used predominantly ocular timolol (39.8%), and the oral preparations propranolol (30.8%) and carvedilol (15.1%). In 154 cases, the pharmacy system generated a warning alert. CONCLUSIONS A substantial number of prescribers was unaware of the co-morbidity or did not regard NS β-blockers contraindicated, despite prevailing clinical guidelines. Improvement programs should target prescribers' awareness and knowledge of NS β-blockers in patients with asthma or COPD.
Collapse
Affiliation(s)
- Esther Kuipers
- Department of IQ Healthcare, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- BENU Apotheek Zeist WestZeistThe Netherlands
| | - Michel Wensing
- Department of IQ Healthcare, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of General Practice and Health Services ResearchUniversity Hospital HeidelbergHeidelbergGermany
| | - Peter A.G.M. De Smet
- Department of IQ Healthcare, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of Clinical Pharmacy, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
| | - Martina Teichert
- Department of IQ Healthcare, Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of Clinical Pharmacy & ToxicologyLeiden University Medical CentreLeidenThe Netherlands
| |
Collapse
|
8
|
Manoharan A, Morrison AE, Lipworth BJ. Effects of the inverse alpha-agonist doxazosin in allergic rhinitis. Clin Exp Allergy 2017; 46:696-704. [PMID: 26741127 DOI: 10.1111/cea.12700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined the paradoxical hypothesis that the alpha-receptor inverse agonist doxazosin might produce beneficial effects in allergic rhinitis. OBJECTIVES To evaluate single and chronic dosing effects of doxazosin on nasal airflow and symptoms in allergic rhinitis. METHODS Fifteen patients randomized to receive 3-5 weeks of oral doxazosin 4 mg daily or placebo in crossover fashion. Measurements were taken at baseline and after first and last doses. RESULTS There was a fall in peak nasal inspiratory flow (PNIF) between baseline vs. first dose of doxazosin: mean difference -19 L/min (95% CI -35 to -2) P = 0.03, with recovery between first and last doses: 21 L/min (95% CI 7-34) P = 0.006. Nasal visual analogue scale (VAS) and blockage scores were worse between baseline vs. first dose of doxazosin: mean difference VAS -10 mm (95% CI -18 to -2) P = 0.02, blockage -0.7 (95% CI -1.3 to -0.1) P = 0.02, with recovery between first and last doses: VAS 15 mm (95% CI 4-25) P = 0.009, blockage 1.1 (95% CI 0.5-1.6) P = 0.001. The oxymetazoline dose-response for PNIF was blunted after single vs chronic dosing with doxazosin: mean difference -17 L/min (95% CI -30 to -4) P = 0.01. Heart rate and diastolic blood pressure showed the same pattern. There was a significant difference between doxazosin and placebo for nasal blockage score and heart rate after single but not chronic dosing. CONCLUSIONS There was a disconnect between single and chronic dosing effects of doxazosin for nasal symptoms, oxymetazoline response and cardiovascular outcomes, in turn suggesting alpha-1 receptor up-regulation.
Collapse
Affiliation(s)
- A Manoharan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - A E Morrison
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - B J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| |
Collapse
|
9
|
β 2-Adrenoceptor signaling in airway epithelial cells promotes eosinophilic inflammation, mucous metaplasia, and airway contractility. Proc Natl Acad Sci U S A 2017; 114:E9163-E9171. [PMID: 29073113 DOI: 10.1073/pnas.1710196114] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The mostly widely used bronchodilators in asthma therapy are β2-adrenoreceptor (β2AR) agonists, but their chronic use causes paradoxical adverse effects. We have previously determined that β2AR activation is required for expression of the asthma phenotype in mice, but the cell types involved are unknown. We now demonstrate that β2AR signaling in the airway epithelium is sufficient to mediate key features of the asthmatic responses to IL-13 in murine models. Our data show that inhibition of β2AR signaling with an aerosolized antagonist attenuates airway hyperresponsiveness (AHR), eosinophilic inflammation, and mucus-production responses to IL-13, whereas treatment with an aerosolized agonist worsens these phenotypes, suggesting that β2AR signaling on resident lung cells modulates the asthma phenotype. Labeling with a fluorescent β2AR ligand shows the receptors are highly expressed in airway epithelium. In β2AR-/- mice, transgenic expression of β2ARs only in airway epithelium is sufficient to rescue IL-13-induced AHR, inflammation, and mucus production, and transgenic overexpression in WT mice exacerbates these phenotypes. Knockout of β-arrestin-2 (βarr-2-/-) attenuates the asthma phenotype as in β2AR-/- mice. In contrast to eosinophilic inflammation, neutrophilic inflammation was not promoted by β2AR signaling. Together, these results suggest β2ARs on airway epithelial cells promote the asthma phenotype and that the proinflammatory pathway downstream of the β2AR involves βarr-2. These results identify β2AR signaling in the airway epithelium as capable of controlling integrated responses to IL-13 and affecting the function of other cell types such as airway smooth muscle cells.
Collapse
|
10
|
Abstract
History suggests β agonists, the cognate ligand of the β2 adrenoceptor, have been used as bronchodilators for around 5,000 years, and β agonists remain today the frontline treatment for asthma and chronic obstructive pulmonary disease (COPD). The β agonists used clinically today are the products of significant expenditure and over 100 year's intensive research aimed at minimizing side effects and enhancing therapeutic usefulness. The respiratory physician now has a therapeutic toolbox of long acting β agonists to prophylactically manage bronchoconstriction, and short acting β agonists to relieve acute exacerbations. Despite constituting the cornerstone of asthma and COPD therapy, these drugs are not perfect; significant safety issues have led to a black box warning advising that long acting β agonists should not be used alone in patients with asthma. In addition there are a significant proportion of patients whose asthma remains uncontrolled. In this chapter we discuss the evolution of β agonist use and how the understanding of β agonist actions on their principal target tissue, airway smooth muscle, has led to greater understanding of how these drugs can be further modified and improved in the future. Research into the genetics of the β2 adrenoceptor will also be discussed, as will the implications of individual DNA profiles on the clinical outcomes of β agonist use (pharmacogenetics). Finally we comment on what the future may hold for the use of β agonists in respiratory disease.
Collapse
Affiliation(s)
| | - Raymond B Penn
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Center for Translational Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ian P Hall
- Division of Respiratory Medicine, University of Nottingham, Nottingham, NG7 2RD, UK.
| |
Collapse
|
11
|
Neef PA, Burrell LM, McDonald CF, Irving LB, Johnson DF, Steinfort DP. Commencement of cardioselective beta-blockers during hospitalisation for acute exacerbations of chronic obstructive pulmonary disease. Intern Med J 2017; 47:1043-1050. [DOI: 10.1111/imj.13518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Pieter A. Neef
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
| | - Louise M. Burrell
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
- Department of Medicine and Cardiology; The University of Melbourne; Melbourne Victoria Australia
| | - Christine F. McDonald
- Department of Respiratory and Sleep Medicine; Austin Health; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Louis B. Irving
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Respiratory and Sleep Medicine; Melbourne Health; Melbourne Victoria Australia
| | - Douglas F. Johnson
- Department of General Medicine; Austin Health; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Daniel P. Steinfort
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Respiratory and Sleep Medicine; Melbourne Health; Melbourne Victoria Australia
| |
Collapse
|
12
|
Joshi R, Valdez D, Kim H, Eikenburg DC, Knoll BJ, Bond RA. Effects of β-blockers on house dust mite-driven murine models pre- and post-development of an asthma phenotype. Pulm Pharmacol Ther 2017; 46:30-40. [PMID: 28729042 DOI: 10.1016/j.pupt.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/16/2017] [Accepted: 07/15/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Our previous studies suggested certain β-adrenoceptor blockers (β-blockers) attenuate the asthma phenotype in ovalbumin driven murine models of asthma. However, the ovalbumin model has been criticized for lack of clinical relevance. METHODS We tested the non-selective β-blockers, carvedilol and nadolol, in house dust mite (HDM) driven murine asthma models where drugs were administered both pre- and post-development of the asthma phenotype. We measured inflammation, mucous metaplasia, and airway hyper-responsiveness (AHR). We also measured the effects of the β-blockers on extracellular-signal regulated kinase (ERK 1/2) phosphorylation in lung homogenates. RESULTS We show that nadolol, but not carvedilol, attenuated inflammation and mucous metaplasia, and had a moderate effect attenuating AHR. Following HDM exposure, ERK1/2 phosphorylation was elevated, but the level of phosphorylation was unaffected by β-blockers, suggesting ERK1/2 phosphorylation becomes dissociated from the asthma phenotype. CONCLUSION Our findings in HDM models administering drugs both pre- and post-development of the asthma phenotype are consistent with previous results using ovalbumin models and show differential effects for nadolol and carvedilol on the asthma phenotype. Lastly, our data suggest that ERK1/2 phosphorylation may be involved in development of the asthma phenotype, but may have a limited role in maintaining the phenotype.
Collapse
Affiliation(s)
- Radhika Joshi
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, 3455 Cullen Blvd., Houston, TX 77204-5027, USA.
| | - Daniel Valdez
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, 3455 Cullen Blvd., Houston, TX 77204-5027, USA.
| | - Hosu Kim
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, 3455 Cullen Blvd., Houston, TX 77204-5027, USA.
| | - Douglas C Eikenburg
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, 3455 Cullen Blvd., Houston, TX 77204-5027, USA.
| | - Brian J Knoll
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, 3455 Cullen Blvd., Houston, TX 77204-5027, USA.
| | - Richard A Bond
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, 3455 Cullen Blvd., Houston, TX 77204-5027, USA.
| |
Collapse
|
13
|
Forkuo GS, Kim H, Thanawala VJ, Al-Sawalha N, Valdez D, Joshi R, Parra S, Pera T, Gonnella PA, Knoll BJ, Walker JKL, Penn RB, Bond RA. Phosphodiesterase 4 Inhibitors Attenuate the Asthma Phenotype Produced by β2-Adrenoceptor Agonists in Phenylethanolamine N-Methyltransferase-Knockout Mice. Am J Respir Cell Mol Biol 2017; 55:234-42. [PMID: 26909542 DOI: 10.1165/rcmb.2015-0373oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Mice lacking the endogenous β2-adrenoceptor (β2AR) agonist epinephrine (phenylethanolamine N-methyltransferase [PNMT]-knockout mice) are resistant to developing an "asthma-like" phenotype in an ovalbumin sensitization and challenge (Ova S/C) model, and chronic administration of β2AR agonists to PNMT-KO mice restores the phenotype. Based on these and other studies showing differential effects of various β2AR ligands on the asthma phenotype, we have speculated that the permissive effect of endogenous epinephrine and exogenous β2AR agonists on allergic lung inflammation can be explained by qualitative β2AR signaling. The β2AR can signal through at least two pathways: the canonical Gαs-cAMP pathway and a β-arrestin-dependent pathway. Previous studies suggest that β-arrestin-2 is required for allergic lung inflammation. On the other hand, cell-based assays suggest antiinflammatory effects of Gαs-cAMP signaling. This study was designed to test whether the in vitro antiinflammatory effects of phosphodiesterase 4 inhibitors, known to increase intracellular cAMP in multiple airway cell types, attenuate the asthma-like phenotype produced by the β2AR agonists formoterol and salmeterol in vivo in PNMT-KO mice, based on the hypothesis that skewing β2AR signaling toward Gαs-cAMP pathway is beneficial. Airway inflammatory cells, epithelial mucus production, and airway hyperresponsiveness were quantified. In Ova S/C PNMT-KO mice, formoterol and salmeterol restored the asthma-like phenotype comparable to Ova S/C wild-type mice. However, coadministration of either roflumilast or rolipram attenuated this formoterol- or salmeterol-driven phenotype in Ova S/C PNMT-KO. These findings suggest that amplification of β2AR-mediated cAMP by phosphodiesterase 4 inhibitors attenuates the asthma-like phenotype promoted by β-agonists.
Collapse
Affiliation(s)
- Gloria S Forkuo
- 1 Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, Texas
| | - Hosu Kim
- 1 Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, Texas
| | - Vaidehi J Thanawala
- 1 Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, Texas
| | - Nour Al-Sawalha
- 1 Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, Texas
| | - Daniel Valdez
- 2 Department of Biology and Biochemistry, University of Houston, Houston, Texas
| | - Radhika Joshi
- 1 Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, Texas
| | | | - Tonio Pera
- 4 Center for Translational Medicine and Jane and Leonard Korman Lung Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Patricia A Gonnella
- 4 Center for Translational Medicine and Jane and Leonard Korman Lung Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Brian J Knoll
- 1 Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, Texas.,2 Department of Biology and Biochemistry, University of Houston, Houston, Texas
| | - Julia K L Walker
- 5 Duke University School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Raymond B Penn
- 4 Center for Translational Medicine and Jane and Leonard Korman Lung Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Richard A Bond
- 1 Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, Texas.,2 Department of Biology and Biochemistry, University of Houston, Houston, Texas
| |
Collapse
|
14
|
Morales DR, Lipworth BJ, Donnan PT, Jackson C, Guthrie B. Respiratory effect of beta-blockers in people with asthma and cardiovascular disease: population-based nested case control study. BMC Med 2017; 15:18. [PMID: 28126029 PMCID: PMC5270217 DOI: 10.1186/s12916-017-0781-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/05/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a common comorbidity in people with asthma. However, safety concerns have caused heterogeneity in clinical guideline recommendations over the use of cardioselective beta-blockers in people with asthma and CVD, partly because risk in the general population has been poorly quantified. The aim of this study was to measure the risk of asthma exacerbations with beta-blockers prescribed to a general population with asthma and CVD. METHODS Linked data from the UK Clinical Practice Research Datalink was used to perform nested case-control studies among people with asthma and CVD matched on age, sex and calendar time. Adjusted incidence rate ratios (IRR) were calculated for the association between oral beta-blocker use and moderate asthma exacerbations (rescue oral steroids) or severe asthma exacerbations (hospitalisation or death) using conditional logistic regression. RESULTS The cohort consisted of 35,502 people identified with active asthma and CVD, of which 14.1% and 1.2% were prescribed cardioselective and non-selective beta-blockers, respectively, during follow-up. Cardioselective beta-blocker use was not associated with a significantly increased risk of moderate or severe asthma exacerbations. Consistent results were obtained following sensitivity analyses and a self-controlled case series approach. In contrast, non-selective beta-blockers were associated with a significantly increased risk of moderate asthma exacerbations when initiated at low to moderate doses (IRR 5.16, 95% CI 1.83-14.54, P = 0.002), and both moderate and severe exacerbations when prescribed chronically at high dose (IRR 2.68, 95% CI 1.08-6.64, P = 0.033 and IRR 12.11, 95% CI 1.02-144.11, P = 0.048, respectively). CONCLUSIONS Cardioselective beta-blockers prescribed to people with asthma and CVD were not associated with a significantly increased risk of moderate or severe asthma exacerbations and potentially could be used more widely when strongly indicated.
Collapse
Affiliation(s)
- Daniel R Morales
- Quality, Safety & Informatics Group, Division of Population Health Sciences, School of Medicine, University of Dundee, Mackenzie Building, Dundee, DD2 4BF, UK.
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Dundee Epidemiology and Biostatistics Unit, Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Cathy Jackson
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Bruce Guthrie
- Quality, Safety & Informatics Group, Division of Population Health Sciences, School of Medicine, University of Dundee, Mackenzie Building, Dundee, DD2 4BF, UK
| |
Collapse
|
15
|
Lipworth B, Jabbal S. Of mice and men-the curious tale of β blockers in asthma. THE LANCET RESPIRATORY MEDICINE 2017; 4:89-91. [PMID: 26868622 DOI: 10.1016/s2213-2600(16)00011-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
| | - Sunny Jabbal
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| |
Collapse
|
16
|
Luo J, Liu YH, Luo W, Luo Z, Liu CT. β 2-adrenoreceptor Inverse Agonist Down-regulates Muscarine Cholinergic Subtype-3 Receptor and Its Downstream Signal Pathways in Airway Smooth Muscle Cells in vitro. Sci Rep 2017; 7:39905. [PMID: 28051147 PMCID: PMC5209700 DOI: 10.1038/srep39905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/29/2016] [Indexed: 02/05/2023] Open
Abstract
Mechanisms underlying β2-adrenoreceptor (β2AR) inverse agonist mediated bronchoprotectiveness remain unknown. We incubated ICI118,551, formoterol, budesonide, and formoterol plus budesonide, as well as ICI118,551 or pindolol plus formoterol, ICI118,551 plus forskolin, SQ22,536 or H89 plus formoterol in ASMCs to detect expressions of M3R, PLCβ1 and IP3. The level of M3R in the presence of 10−5 mmol/L ICI118,551 were significantly decreased at 12 h, 24 h and 48 h (P < 0.05), and at 24 h were significantly reduced in ICI118,551 with concentration of 10−5 mmol/L, 10−6 mmol/L, 10−7 mmol/L, and 10−8 mmol/L (P < 0.05). The level of IP3 in 10−5 mmol/L ICI118,551 was significantly diminished at 24 h (P < 0.01), except for that at 1 h, neither was in the level of PLCβ1. A concentration of 10−5 mmol/L ICI118,551 at 24 h showed a significant reduction of M3R level compared to formoterol (P < 0.01), budesonide (P < 0.01), and formoterol + budesonide (P < 0.05), but significant reduction of PLCβ1 and IP3 was only found between 10−5 mmol/L ICI118,551 and formoterol at 24 h, but not in the comparison of budesonide or formoterol + budesonide. Pindolol and H89 could not inhibit the formoterol-induced expression of M3R (P > 0.05), but SQ22,536 significantly antagonized the formoterol-induced M3R expression (P < 0.05). In conclusions, β2AR inverse agonist, ICI118,551, exerts similar bronchoprotective effects to corticosteroids via decreasing the expression of M3R and inhibiting the production of IP3.
Collapse
Affiliation(s)
- Jian Luo
- Department of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuan-Hua Liu
- Department of Respiratory Diseases, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Wei Luo
- Department of Respiratory Diseases, The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China
| | - Zhu Luo
- Department of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chun-Tao Liu
- Department of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, 610041, China
| |
Collapse
|
17
|
Pité H, da Cruz MB, Morais-Almeida M. Obstructive lung diseases and beta-blockers: Where do we stand? Eur J Intern Med 2016; 34:e32-e33. [PMID: 27179413 DOI: 10.1016/j.ejim.2016.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Helena Pité
- Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal; CEDOC, Chronic Diseases Research Center, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Marisa Braga da Cruz
- Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal; CINTESIS, Center for Research in Health Technologies and Information Systems, Porto, Portugal
| |
Collapse
|
18
|
Bond RA, Thanawala VJ, Parra S, Leff P. Differences in asthma study models and the effectiveness of β2 -adrenoceptor ligands: response to Lipworth et al. Br J Pharmacol 2016; 173:250-1. [PMID: 26687674 DOI: 10.1111/bph.13334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/14/2015] [Indexed: 01/14/2023] Open
Affiliation(s)
- Richard A Bond
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - Vaidehi J Thanawala
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA.,Department of Integrative Biology and Pharmacology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Paul Leff
- Consultant in Pharmacology, Cheshire, UK
| |
Collapse
|
19
|
Lipworth BJ, Anderson WJ, Short PM. From mouse to man: predicting biased effects of beta-blockers in asthma. Br J Pharmacol 2016; 173:248-9. [PMID: 26687673 DOI: 10.1111/bph.13335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/08/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- B J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Dundee, UK
| | - W J Anderson
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Dundee, UK
| | - P M Short
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Dundee, UK
| |
Collapse
|
20
|
Lipworth B, Wedzicha J, Devereux G, Vestbo J, Dransfield MT. Beta-blockers in COPD: time for reappraisal. Eur Respir J 2016; 48:880-8. [PMID: 27390282 DOI: 10.1183/13993003.01847-2015] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/23/2016] [Indexed: 12/21/2022]
Abstract
The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in chronic obstructive pulmonary disease (COPD). The use of beta-blockers in COPD has been proposed because of their known cardioprotective effects as well as reducing heart rate and improving systolic function. Despite the proven cardiac benefits of beta-blockers post-myocardial infarction and in heart failure they remain underused due to concerns regarding potential bronchoconstriction, even with cardioselective drugs. Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well tolerated in older patients with COPD who have other comorbidities. Medium-term prospective placebo-controlled safety studies in COPD are warranted to reassure prescribers regarding the pulmonary and cardiac tolerability of beta-blockers as well as evaluating their potential interaction with concomitant inhaled long-acting bronchodilator therapy. Several retrospective observational studies have shown impressive reductions in mortality and exacerbations conferred by beta-blockers in COPD. However, this requires confirmation from long-term prospective placebo-controlled randomised controlled trials. The real challenge is to establish whether beta-blockers confer benefits on mortality and exacerbations in all patients with COPD, including those with silent cardiovascular disease where the situation is less clear.
Collapse
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Jadwiga Wedzicha
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Graham Devereux
- Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jørgen Vestbo
- Centre for Respiratory Medicine and Allergy, University Hospital South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Alabama, AL, USA Birmingham VA Medical Center, Alabama, AL, USA
| |
Collapse
|
21
|
Lee SH, Chang GT, Zhang X, Lee H. Acupoint Herbal Patching for Asthma: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Medicine (Baltimore) 2016; 95:e2439. [PMID: 26765427 PMCID: PMC4718253 DOI: 10.1097/md.0000000000002439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acupoint herbal patching (AHP), which involves local point stimulation with a herbal medicine patch, has long been used to treat patients with asthma in East Asian countries. However, its evidence is equivocal. This systematic review aims to summarize and critically evaluate the efficacy and safety of AHP for asthma.A literature search was conducted in PubMed, EMBASE, the Cochrane library, and the China National Knowledge Infrastructure for studies published on or before April 2014, which were randomized controlled trials (RCTs) examining AHP therapy by itself or in combination with other treatments in asthma patients. Trials needed to report pulmonary function outcomes to be included in analyses. The risk of bias of included studies was assessed using the Cochrane risk of bias assessment tool. For statistical pooling, risk ratio, mean difference (MD), or standardized MD was calculated with 95% confidence intervals (CIs) in a random-effects model.We ultimately included 16 RCTs with 1287 asthmatic patients in analyses. Treatment with AHP improved forced expiratory volume in 1 second (FEV1) by 13% (MD = 12.99%, 95% CI 5.17%-20.81%) and asthmatic symptoms by 60% (risk ratio of unchanged or getting worse symptoms with AHP = 0.4, 95% CI 0.27-0.58) over that observed with placebo. However, evidence is limited due to the heterogeneity and paucity of data. When added to conventional therapies, AHP significantly improved the FEV1/forced vital capacity ratio by 11.6% (95% CI 8.49%-14.79%) and reduced the risk of asthmatic symptoms by 69% (95% CI 0.16-0.58). Compared with conventional medication, AHP significantly improved FEV1 (standardized MD = 0.46, 95% CI 0.05-0.87), but a substantial heterogeneity was detected (I 2= 53%). When added to Chinese herbal medicine, there were no additional benefits of AHP on pulmonary function or global symptom improvement. No serious adverse events were associated with AHP.Evidence for AHP efficacy is encouraging, but not conclusive, because of clinical diversity and the high risk of bias in the examined studies. Further clinical and basic research is needed to determine the role of AHP in lung function and symptom improvement in patients with asthma.
Collapse
Affiliation(s)
- Sun Haeng Lee
- From the Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea (SHL, GTC); Department of Pediatrics, Korean Medicine Hospital, Kyung Hee University Medical Center, Seoul, Korea (SHL); Department of Pediatrics of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea (GTC); Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea (XZ, HL); and Department of Korean Medical Science, Graduate School, Kyung Hee University, Seoul, Korea (XZ, HL)
| | | | | | | |
Collapse
|
22
|
Tan DWS, Wong JL, Tie ST, Abisheganaden JA, Lim AYH, Wong WSF. β 2-adrenoceptor in obstructive airway diseases: Agonism, antagonism or both? World J Respirol 2015; 5:199-206. [DOI: 10.5320/wjr.v5.i3.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/27/2015] [Accepted: 10/08/2015] [Indexed: 02/06/2023] Open
Abstract
Obstructive airway disease is a complex disease entity including several maladies characterized by bronchoconstriction and abnormal airway inflammation. Reversing bronchoconstriction leads to symptomatic relief and improvement in quality of life, both in reversible (bronchial asthma) and partially reversible (chronic obstructive airway disease) obstructive airway diseases. β2-adrenoceptor expressed in human airway is the main β-receptor subtype, and its activation in airway smooth muscle cells leads to bronchodilatation. Drugs targeting β-adrenoceptors have been around for many years, for which agonists of the receptors are used in bronchodilation while antagonists are used in cardiovascular diseases. This review article summarizes the effect and usage of β2-agonist in obstructive airway disease, addressing the benefits and potential risks of β2-agonist. The article also looks at the safety of β-blocker usage for cardiovascular disease in patients with obstructive airway disease. There is also emerging evidence that non-selective β-blockers with inverse agonism ironically can have long-term beneficial effects in obstructive airway disease that is beyond cardiovascular protection. Further trials are urgently needed in this area as it might lead to a dramatic turnaround in clinical practice for obstructive airway diseases as has already been seen in the usage of β-blockers for heart failure.
Collapse
|
23
|
Knight JM, Mak G, Shaw J, Porter P, McDermott C, Roberts L, You R, Yuan X, Millien VO, Qian Y, Song LZ, Frazier V, Kim C, Kim JJ, Bond RA, Milner JD, Zhang Y, Mandal PK, Luong A, Kheradmand F, McMurray JS, Corry DB. Long-Acting Beta Agonists Enhance Allergic Airway Disease. PLoS One 2015; 10:e0142212. [PMID: 26605551 PMCID: PMC4659681 DOI: 10.1371/journal.pone.0142212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/19/2015] [Indexed: 01/11/2023] Open
Abstract
Asthma is one of the most common of medical illnesses and is treated in part by drugs that activate the beta-2-adrenoceptor (β2-AR) to dilate obstructed airways. Such drugs include long acting beta agonists (LABAs) that are paradoxically linked to excess asthma-related mortality. Here we show that LABAs such as salmeterol and structurally related β2-AR drugs such as formoterol and carvedilol, but not short-acting agonists (SABAs) such as albuterol, promote exaggerated asthma-like allergic airway disease and enhanced airway constriction in mice. We demonstrate that salmeterol aberrantly promotes activation of the allergic disease-related transcription factor signal transducer and activator of transcription 6 (STAT6) in multiple mouse and human cells. A novel inhibitor of STAT6, PM-242H, inhibited initiation of allergic disease induced by airway fungal challenge, reversed established allergic airway disease in mice, and blocked salmeterol-dependent enhanced allergic airway disease. Thus, structurally related β2-AR ligands aberrantly activate STAT6 and promote allergic airway disease. This untoward pharmacological property likely explains adverse outcomes observed with LABAs, which may be overcome by agents that antagonize STAT6.
Collapse
MESH Headings
- Adrenergic beta-2 Receptor Agonists/adverse effects
- Albuterol/therapeutic use
- Animals
- Anti-Asthmatic Agents/adverse effects
- Arrestins/deficiency
- Arrestins/genetics
- Aspergillosis, Allergic Bronchopulmonary/drug therapy
- Aspergillosis, Allergic Bronchopulmonary/genetics
- Aspergillosis, Allergic Bronchopulmonary/metabolism
- Aspergillosis, Allergic Bronchopulmonary/pathology
- Aspergillus niger/physiology
- Asthma/chemically induced
- Asthma/drug therapy
- Asthma/genetics
- Asthma/metabolism
- Bronchoconstriction/drug effects
- Carbazoles/adverse effects
- Carvedilol
- Disease Models, Animal
- Female
- Formoterol Fumarate/adverse effects
- Gene Expression
- Humans
- Lung/drug effects
- Lung/metabolism
- Lung/pathology
- Mice
- Mice, Knockout
- Peptidomimetics/pharmacology
- Propanolamines/adverse effects
- Receptors, Adrenergic, beta-2/deficiency
- Receptors, Adrenergic, beta-2/genetics
- STAT6 Transcription Factor/agonists
- STAT6 Transcription Factor/antagonists & inhibitors
- STAT6 Transcription Factor/genetics
- STAT6 Transcription Factor/metabolism
- Salmeterol Xinafoate/adverse effects
- beta-Arrestins
Collapse
Affiliation(s)
- John M Knight
- Departments of Pathology & Immunology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Garbo Mak
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Joanne Shaw
- Department of Otorhinolaryngolgy - Head and Neck Surgery, University of Texas Medical School at Houston, Houston, Texas, United States of America
| | - Paul Porter
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Catherine McDermott
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Luz Roberts
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Ran You
- Departments of Pathology & Immunology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Xiaoyi Yuan
- Departments of Pathology & Immunology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Valentine O Millien
- Department of Medicine and the Translational Biology and Molecular Medicine Program, Baylor College of Medicine, Houston, Texas, United States of America
| | - Yuping Qian
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Li-Zhen Song
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Vincent Frazier
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Choel Kim
- Departments of Pharmacology, and Biochemistry & Molecular Biology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jeong Joo Kim
- Department of Biochemistry & Molecular Biology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Richard A Bond
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston College of Pharmacy, Houston, Texas, United States of America
| | - Joshua D Milner
- Laboratory of Allergic Diseases, National Institutes of Allergic and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Yuan Zhang
- Laboratory of Allergic Diseases, National Institutes of Allergic and Infectious Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Pijus K Mandal
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Amber Luong
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center and the Center for Immunology and Autoimmune Diseases, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, University of Texas Medical School at Houston, Houston, Texas, United States of America
| | - Farrah Kheradmand
- Departments of Medicine and Pathology & Immunology, Translational Biology and Molecular Medicine Program, and the Biology of Inflammation Center, Baylor College of Medicine and the Michael E. DeBakey VA Center for Translational Research on Inflammatory Diseases, Houston, Texas, United States of America
| | - John S McMurray
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - David B Corry
- Departments of Medicine and Pathology & Immunology, Translational Biology and Molecular Medicine Program, and the Biology of Inflammation Center, Baylor College of Medicine and the Michael E. DeBakey VA Center for Translational Research on Inflammatory Diseases, Houston, Texas, United States of America
| |
Collapse
|
24
|
Thanawala VJ, Valdez DJ, Joshi R, Forkuo GS, Parra S, Knoll BJ, Bouvier M, Leff P, Bond RA. β-Blockers have differential effects on the murine asthma phenotype. Br J Pharmacol 2015. [PMID: 26211486 DOI: 10.1111/bph.13253] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Our previous studies have shown the β2 -adrenoceptor and its endogenous ligand, adrenaline, are required for development of the asthma phenotype in murine asthma models. Chronic administration of some, but not other, β-blockers attenuated the asthma phenotype and led us to hypothesize that biased signalling was the basis of their differential effects, experimentally and clinically. EXPERIMENTAL APPROACH We used mice with no detectable systemic adrenaline (PNMT(-/-) ) and wild-type (WT) mice to study the effects of four β-blockers, alprenolol, carvedilol, propranolol and nadolol, in an ovalbumin sensitization and challenge (Ova S/C) murine model of asthma. The parameters measured were inflammatory cell infiltration, mucous metaplasia and airway hyperresponsiveness. To interpret the pharmacological action of these ligands quantitatively, we conducted computer simulations of three-state models of receptor activation. KEY RESULTS Ova S/C PNMT(-/-) mice do not develop an asthma phenotype. Here, we showed that administration of alprenolol, carvedilol or propranolol in the absence of interference from adrenaline using Ova S/C PNMT(-/-) mice resulted in the development of an asthma phenotype, whereas nadolol had no effect. Ova S/C WT mice did develop an asthma phenotype, and administration of alprenolol, propranolol and carvedilol had no effect on the asthma phenotype. However, nadolol prevented development of the asthma phenotype in Ova S/C WT mice. Computer simulations of these four ligands were consistent with the isolated three-state receptor model. CONCLUSION AND IMPLICATIONS β-Blockers have different effects on the murine asthma phenotype that correlate with reported differences in activation or inhibition of downstream β2 -adrenoceptor signalling pathways.
Collapse
Affiliation(s)
- V J Thanawala
- Department of Integrative and Biology Pharmacology, University of Texas Health Science Center, Houston, TX, USA
| | - D J Valdez
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - R Joshi
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - G S Forkuo
- Department of Chemistry and Biochemistry, University of Wisconsin, Milwaukee Institute for Drug Discovery, Milwaukee, WI
| | - S Parra
- Vapogenix, Inc., Houston, TX, USA
| | - B J Knoll
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - M Bouvier
- Department of Biochemistry, Université de Montréal, Montréal, QC, Canada.,Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, QC, Canada
| | - P Leff
- Consultant in Pharmacology, Cheshire, UK
| | - R A Bond
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| |
Collapse
|
25
|
Usefulness of impulse oscillometry for the assessment of airway hyperresponsiveness in mild-to-moderate adult asthma. Ann Allergy Asthma Immunol 2015; 115:17-20. [PMID: 26123421 DOI: 10.1016/j.anai.2015.04.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/02/2015] [Accepted: 04/17/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Impulse oscillometry (IOS) is a novel method of assessing airway resistance. IOS is rarely used in assessing airway resistance after bronchoprovocation in adult asthma. OBJECTIVE To ascertain the degree of change in IOS measurements seen in patients with asthma undergoing bronchial challenge testing. METHODS Patients 18 to 65 years old with mild to moderate asthma, forced expiratory volume in 1 second (FEV1) greater than 80% predicted, and diurnal FEV1 variation less than 30% and taking inhaled corticosteroid (≤1,000 μg/day of beclomethasone dipropionate equivalent dose) were recruited. Sequential spirometry and IOS results were measured during bronchial challenge testing to inhaled methacholine and histamine. RESULTS The magnitude of percentage of change demonstrated in total airway resistance at 5 Hz was greater than that observed for FEV1 in the 2 bronchial challenge tests. For example, at a methacholine provocation concentration that caused a decrease in FEV1 of 20%, a 43.5% change (95% confidence interval 29.4-57.5) was seen in total airway resistance at 5 Hz as measured by IOS compared with a 23.3% change (95% confidence interval 18.7-27.9) in FEV1. The magnitude of change seen with other IOS outcomes, including peripheral airway resistance, area under the curve, and resonant frequency, also was greater compared with spirometry. CONCLUSION The potential application of IOS in the assessment of airway hyperresponsiveness in adult asthma has been demonstrated. Further population studies are required. TRIAL REGISTRATION www.clinicaltrials.gov (NCT01074853).
Collapse
|
26
|
Justet A, Pradère P, Taillé C. [Current and prospective issues about adult asthma]. Rev Mal Respir 2015; 32:629-38. [PMID: 26163989 DOI: 10.1016/j.rmr.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 12/12/2014] [Indexed: 11/17/2022]
Abstract
The management of asthma treatment is likely to change in coming years, with the development of a more personalized approach. Biological therapies targeting Th2 cytokines (IL-4, IL-5 and IL-13) offer new treatment pathways for patients with severe asthma and high Th2 activity. Bronchial thermoplasty is the only treatment for severe asthma that could provide a long standing effect, but many questions still remain and its use is restricted to clinical research. Weight loss should be a goal during long-term management of obese asthmatics. Involvement of a new inflammatory pathway including IL-1 and IL-17 in a murine model of obesity and asthma may lead to new therapies in this subgroup of asthmatics.
Collapse
Affiliation(s)
- A Justet
- Service de pneumologie et centre de compétence pour les maladies pulmonaires rares, hôpital Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - P Pradère
- Service de pneumologie et centre de compétence pour les maladies pulmonaires rares, hôpital Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - C Taillé
- Service de pneumologie et centre de compétence pour les maladies pulmonaires rares, hôpital Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
| |
Collapse
|
27
|
Yoon HI. Respiratory review of 2014: asthma. Tuberc Respir Dis (Seoul) 2014; 77:237-42. [PMID: 25580139 PMCID: PMC4286780 DOI: 10.4046/trd.2014.77.6.237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 11/24/2022] Open
Abstract
Asthma is a chronic inflammatory disease of the airway that comprises a variety of etiologies and inflammatory phenotypes. Clinically, there is a wide range of patients with varying severities and responses to individual drugs. The introduction of inhaled corticosteroid therapy has dramatically changed the treatment of asthma. Recent development of new therapies suggests the possibility of another breakthrough. These can be categorized as follows: anti-cytokine therapies that usually target eosinophilic inflammation, sublingual immunotherapy, and bronchial thermoplasty. In this paper, we will review the major articles related to asthma treatment that were published in 2013.
Collapse
Affiliation(s)
- Ho Il Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
28
|
The inverse agonist propranolol confers no corticosteroid-sparing activity in mild-to-moderate persistent asthma. Clin Sci (Lond) 2014; 127:635-43. [PMID: 24938324 DOI: 10.1042/cs20140249] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The murine asthma model shows that switching off airway β2 receptors with an inverse agonist may confer anti-inflammatory effects as well as corticosteroid-sparing activity. We have assessed for any corticosteroid-sparing effects of propranolol, an inverse agonist, added to low-dose inhaled corticosteroid (ICS) compared with higher dose ICS. A randomized double-blind placebo-controlled cross-over trial in mild-to-moderate persistent asthmatic patients was performed. After a run-in (2 weeks) on hydrofluoroalkane-beclometasone dipropionate (HFA-BDP) at 100 μg/day (HFA-BDP100), patients received randomized treatments (4 weeks) with propranolol at 80 mg/day plus HFA-BDP at 100 μg/day compared with placebo plus HFA-BDP at 400 μg/day (HFA-BDP400). Propranolol was up-titrated to 80 mg/day over the initial 2 weeks. Tiotropium was co-administered until 5 days before each histamine challenge (the primary outcome). Sixteen patients completed the study [mean age, 38 years; forced expiratory volume in 1 s (FEV1), 86.4%; histamine provocative concentration causing a 20% fall in FEV1 (PC20), 1.39 mg/ml; ICS dose, 406 μg/day]. Histamine PC20 was unchanged by adding propranolol to HFA-BDP100 compared with baseline (HFA-BDP100) {0.17 doubling dilution (dd) difference [95% confidence interval (CI): -0.58 to 0.92]}, but there was a significant improvement with HFA-BDP400 compared with both baseline [1.05 dd (95% CI: 0.43-1.66); P=0.02], and propranolol+HFA-BDP100 [0.88 dd (95% CI: 0.45-1.30); P=0.006]. Significant improvements were also observed with HFA-BDP400 for exhaled nitric oxide, blood eosinophils, serum eosinophilic cationic protein and asthma quality-of-life questionnaire symptoms compared with propranolol+HFA-BDP100. Salbutamol recovery post-challenge was partially blunted by propranolol (median prolongation 5 min; P=0.002). Domiciliary evening FEV1 also fell with propranolol+HFA-BDP100 [mean reduction from baseline 0.22 litres (95% CI: 0.10-0.34); P=0.012], whereas Asthma Control Questionnaire remained unchanged. In conclusion, the inverse agonist propranolol produced no improvements when given with low-dose ICS, whereas further significant improvements in airway hyper-responsiveness and inflammation were demonstrated with higher dose ICS. Thus, propranolol does not confer corticosteroid-sparing activity in persistent asthma.
Collapse
|
29
|
Barnes PJ, Casale TB, Dahl R, Pavord ID, Wechsler ME. The Asthma Control Questionnaire as a clinical trial endpoint: past experience and recommendations for future use. Allergy 2014; 69:1119-40. [PMID: 25039248 DOI: 10.1111/all.12415] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2014] [Indexed: 12/24/2022]
Abstract
The goal of asthma treatment is to control the disease according to guidelines issued by bodies such as the Global Initiative for Asthma. Effective control is dependent upon evaluation of symptoms, initiation of appropriate treatment and minimization of the progressive adverse effects of the disease and its therapies. Although individual outcome measures have been shown to correlate with asthma control, composite endpoints are preferred to enable more accurate and robust monitoring of the health of the individual patient. A number of validated instruments are utilized to capture these component endpoints; however, there is no consensus on the optimal instrument for use in clinical trials. The Asthma Control Questionnaire (ACQ) has been shown to be a valid, reliable instrument that allows accurate and reproducible assessment of asthma control that compares favourably with other commonly used instruments. This analysis provides a summary of the use of ACQ in phase II, III and IV asthma trials. Comparisons between the ACQ and other instruments are also presented. Our analysis suggests that the ACQ is a valid and robust measure for use as a primary or secondary endpoint in future clinical trials.
Collapse
Affiliation(s)
- P. J. Barnes
- Airway Disease Section; National Heart & Lung Institute; London UK
| | | | - R. Dahl
- Allergy Centre; Odense University Hospital; Odense Denmark
| | - I. D. Pavord
- Department of Respiratory Medicine; Nuffield Department of Medicine; University of Oxford; Oxford UK
| | - M. E. Wechsler
- Department of Medicine; National Jewish Health; Denver CO USA
| |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW β2-Agonists and muscarinic antagonists are widely used to treat asthma and chronic obstructive pulmonary disease (COPD), and a number of novel drug targets are being investigated for potential clinical utility. This review will summarize current developments in the field. RECENT FINDINGS The clinical effectiveness of a number of once a day inhaled β2-agonists and muscarinic antagonists is a major advance providing sustained bronchodilation in asthma and COPD. The identification of novel targets (e.g. bitter taste receptor TASR2), the demonstration of clinical effectiveness of others [e.g. phosphodiesterase (PDE)3/4] and exploring the potential of inverse agonists/biased agonists are evidence of continuing interest in the development of novel bronchodilators. SUMMARY Novel long-acting β2-agonists (e.g. indacaterol, vilanterol, olodaterol and carmoterol) and muscarinic antagonists (e.g. tiotropium, aclidinium, glycopyrronium and umeclidinium bromide) document sustained bronchodilation and their combination provides additional benefits over monotherapy. Not surprisingly, inhaled long-acting β2-agonist and long-acting muscarinic antagonists remain the drugs of choice for maintenance bronchodilation. However, there is a continued interest in developing novel bronchodilators illustrated by the clinical effectiveness of long acting mixed PDE3/4 inhibitors, vasointestinal peptide adenylyl cyclase agonists and inverse agonists/biased agonists for the β2-adrenoceptor, and the identification of intracellular (e.g. Rho kinase, exchange proteins activated by cyclic AMP) and cell surface (e.g. TAS2R, natriuretic peptide receptor) targets.
Collapse
|
31
|
Affiliation(s)
- Lauren Cohn
- 1 Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | | |
Collapse
|
32
|
Wasilewski NV, Lougheed MD, Fisher JT. Changing face of β2-adrenergic and muscarinic receptor therapies in asthma. Curr Opin Pharmacol 2014; 16:148-56. [PMID: 24922602 DOI: 10.1016/j.coph.2014.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 05/08/2014] [Accepted: 05/11/2014] [Indexed: 02/07/2023]
Abstract
Despite current available treatment options, a significant proportion of patients with asthma remain uncontrolled and asthma pharmacotherapy continues to evolve. β2-Adrenergic receptor agonists play a major role as bronchodilators in asthma therapy, although new perspectives reflect the potential for bias G-protein coupled receptor signaling pathways. Due to the success of muscarinic antagonists in chronic obstructive pulmonary disease, and the elucidation that muscarinic receptors play a role in airway remodeling, muscarinic receptors represent an attractive therapeutic target in asthma. Although short-acting muscarinic antagonists are currently limited to their use in acute asthma and as alternative bronchodilators in individuals who experience side effects with β2-agonists, recent clinical trials indicate that the long-acting muscarinic antagonist, tiotropium, deserves consideration as a potential therapeutic agent for select populations. The continued evolution of anticholinergic therapy in asthma will require appropriately designed studies to assess mechanisms, efficacy and safety in asthma.
Collapse
Affiliation(s)
- Nastasia V Wasilewski
- Division of Respirology, Department of Medicine and Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - M Diane Lougheed
- Division of Respirology, Department of Medicine and Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - John T Fisher
- Division of Respirology, Department of Medicine and Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
| |
Collapse
|
33
|
Morales DR, Jackson C, Lipworth BJ, Donnan PT, Guthrie B. Adverse respiratory effect of acute β-blocker exposure in asthma: a systematic review and meta-analysis of randomized controlled trials. Chest 2014; 145:779-786. [PMID: 24202435 DOI: 10.1378/chest.13-1235] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND β-Blockers are avoided in asthma over concerns regarding acute bronchoconstriction. Risk is greatest following acute exposure, including the potential for antagonism of β2-agonist rescue therapy. METHODS A systematic review of databases was performed to identify all randomized, blinded, placebo-controlled clinical trials evaluating acute β-blocker exposure in asthma. Effect estimates for changes in respiratory function, symptoms, and β2-agonist response were pooled using random effects meta-analysis with heterogeneity investigated. RESULTS Acute selective β-blockers in the doses given caused a mean change in FEV1 of −6.9% (95% CI, −8.5 to −5.2), a fall in FEV1 of ≥20% in one in eight patients (P=.03), symptoms affecting one in 33 patients (P=.18), and attenuation of concomitant β2-agonist response of −10.2% (95% CI, −14.0 to −6.4). Corresponding values for acute nonselective β-blockers in the doses given were −10.2% (95% CI, −14.7 to −5.6), one in nine patients (P=.02), one in 13 patients (P=.14), and −20.0% (95% CI, −29.4 to −10.7). Following investigation of heterogeneity, clear differences were found for celiprolol and labetalol. A dose-response relationship was demonstrated for selective β-blockers. CONCLUSIONS Selective β-blockers are better tolerated but not completely risk-free. Risk from acute exposure may be mitigated using the smallest dose possible and β-blockers with greater β1-selectivity. β-Blocker-induced bronchospasm responded partially to β2-agonists in the doses given with response blunted more by nonselective β-blockers than selective β-blockers. Use of β-blockers in asthma could possibly be based upon a risk assessment on an individual patient basis.
Collapse
Affiliation(s)
- Daniel R Morales
- Quality, Safety, and Informatics Group, Medical Research Institute, University of Dundee, Dundee.
| | - Cathy Jackson
- Bute Medical School, University of St Andrews, Fife, Scotland
| | - Brian J Lipworth
- Asthma and Allergy Research Group, Medical Research Institute, University of Dundee, Dundee
| | - Peter T Donnan
- Dundee Epidemiology and Biostatistics Unit, Medical Research Institute, University of Dundee, Dundee
| | - Bruce Guthrie
- Quality, Safety, and Informatics Group, Medical Research Institute, University of Dundee, Dundee
| |
Collapse
|
34
|
Pera T, Penn RB. Crosstalk between beta-2-adrenoceptor and muscarinic acetylcholine receptors in the airway. Curr Opin Pharmacol 2014; 16:72-81. [PMID: 24747364 DOI: 10.1016/j.coph.2014.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/17/2014] [Accepted: 03/21/2014] [Indexed: 01/12/2023]
Abstract
The M3 and M2 muscarinic acetylcholine receptors (mAChRs) and beta-2-adrenoceptors (β2ARs) are important regulators of airway cell function, and drugs targeting these receptors are among the first line drugs in the treatment of the obstructive lung diseases asthma and chronic obstructive lung disease (COPD). Cross-regulation or crosstalk between mAChRs and β2ARs in airway smooth muscle (ASM) helps determine the contractile state of the muscle, thus airway diameter and resistance to airflow. In this review we will detail mAChR and β2AR-signaling and crosstalk, focusing on events in the ASM cell but also addressing the function of these receptors in other cell types that impact airway physiology. We conclude by discussing how recent advances in GPCR pharmacology offer a unique opportunity to fine tune mAChR and β2AR signaling and their crosstalk, and thereby produce superior therapeutics for obstructive lung and other diseases.
Collapse
Affiliation(s)
- Tonio Pera
- Center for Translational Medicine, Jefferson-Jane and Leonard Korman Lung Center, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Raymond B Penn
- Center for Translational Medicine, Jefferson-Jane and Leonard Korman Lung Center, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| |
Collapse
|
35
|
Kazani S, Israel E. Reply: "The intrinsic bias of generalizations" and "Far from 'disappointing'". Am J Respir Crit Care Med 2014; 189:361-2. [PMID: 24484336 DOI: 10.1164/rccm.201308-1410le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
36
|
|
37
|
Affiliation(s)
- Raymond B Penn
- 1 Thomas Jefferson University Philadelphia, Pennsylvania
| |
Collapse
|
38
|
Lipworth B, Short P, Anderson W, Williamson P. Reply: Pharmacological obfuscation of clinical relevance. Am J Respir Crit Care Med 2014; 189:360-1. [PMID: 24484335 DOI: 10.1164/rccm.201306-1166le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
39
|
Thanawala VJ, Forkuo GS, Stallaert W, Leff P, Bouvier M, Bond R. Ligand bias prevents class equality among beta-blockers. Curr Opin Pharmacol 2014; 16:50-7. [PMID: 24681351 DOI: 10.1016/j.coph.2014.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/26/2014] [Accepted: 03/03/2014] [Indexed: 01/14/2023]
Abstract
β-Blockers are used for a wide range of diseases from hypertension to glaucoma. In some diseases/conditions all β-blockers are effective, while in others only certain subgroups are therapeutically beneficial. The best-documented example for only a subset of β-blockers showing clinical efficacy is in heart failure, where members of the class have ranged from completely ineffective, to drugs of choice for treating the disease. Similarly, β-blockers were tested in murine asthma models and two pilot clinical studies. A different subset was found to be effective for this clinical indication. These findings call into question the current system of classifying these drugs. To consider 'β-blockers', as a single class is misleading when considering their rigorous pharmacological definition and their appropriate clinical application.
Collapse
Affiliation(s)
- Vaidehi J Thanawala
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - Gloria S Forkuo
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - Wayne Stallaert
- Department of Biochemistry, Université de Montréal, Montréal, Quebec, Canada; Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Quebec, Canada
| | - Paul Leff
- Consultant in Pharmacology, Cheshire, UK
| | - Michel Bouvier
- Department of Biochemistry, Université de Montréal, Montréal, Quebec, Canada; Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Quebec, Canada
| | - Richard Bond
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA.
| |
Collapse
|
40
|
Anderson WJ, Short PM, Manoharan A, Lipworth JLR, Lipworth BJ. Influence of β2-adrenoceptor 16 genotype on propranolol-induced bronchoconstriction in patients with persistent asthma. Ann Allergy Asthma Immunol 2014; 112:475-6. [PMID: 24650443 DOI: 10.1016/j.anai.2014.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/06/2014] [Accepted: 02/25/2014] [Indexed: 11/24/2022]
Affiliation(s)
- William J Anderson
- Asthma and Allergy Research Group, University of Dundee, Dundee, Scotland
| | - Philip M Short
- Asthma and Allergy Research Group, University of Dundee, Dundee, Scotland
| | - Arvind Manoharan
- Asthma and Allergy Research Group, University of Dundee, Dundee, Scotland
| | | | - Brian J Lipworth
- Asthma and Allergy Research Group, University of Dundee, Dundee, Scotland.
| |
Collapse
|
41
|
Apter AJ. Advances in adult asthma diagnosis and treatment in 2013. J Allergy Clin Immunol 2014; 133:49-56. [PMID: 24369799 DOI: 10.1016/j.jaci.2013.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
In 2013, several themes emerged: (1) a dedicated search for new therapies using new mechanisms; (2) the importance of the plasticity of the immune system (eg, that molecules that mediate inflammation in one setting can promote its resolution and return to homeostasis in other circumstances); (3) the complex role of viruses in asthma exacerbations; (4) the similarities and differences among asthma, asthma in smokers, and chronic obstructive pulmonary disease; and (5) the importance of understanding asthma phenotypes and their stability over time. Once new therapeutics pass the initial clinical trials, patient-oriented and real-world research will be needed.
Collapse
Affiliation(s)
- Andrea J Apter
- Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pa.
| |
Collapse
|
42
|
Short PM, Anderson WJ, Williamson PA, Lipworth BJ. Effects of intravenous and oral β-blockade in persistent asthmatics controlled on inhaled corticosteroids. Heart 2013; 100:219-23. [PMID: 24203262 DOI: 10.1136/heartjnl-2013-304769] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Despite their benefits in the treatment of cardiovascular disease, β-blockers are seldom used to treat asthmatics. We assessed the safety and tolerability of acute dosing with esmolol and propranolol in patients with asthma. DESIGN Post-hoc analysis of a double blind, randomised, placebo controlled trial of β-blocker use in asthma. PATIENTS Mild-to-moderate asthmatics on inhaled corticosteroids. INTERVENTIONS Each participant underwent a 6-8 week dose titration of oral propranolol. A subgroup received an intravenous bolus dose of esmolol (0.5 mg/kg). Measurements were recorded pre- and post-esmolol and first dose exposure to 10 mg, 20 mg, and 80 mg of propranolol. Tiotropium was given concurrently with propranolol. Bronchoconstriction was reflected as a fall in forced expiratory volume in 1 s (FEV1) or increase in total airway resistance at 5 Hz (R5). RESULTS 12 patients completed the trial. There were no adverse effects on FEV1% or R5% following intravenous esmolol. There were significant reductions at 2 min post-esmolol in heart rate (-4.7 beats/min (bpm), 95% CI -7.9 to -1.3 bpm; p=0.002) and systolic blood pressure (-5.9 mm Hg, 95% CI -11.4 to -0.4 mm Hg; p=0.03). No bronchoconstriction was seen during up titration following the first dose of 10 mg, 20 mg or 80 mg of propranolol in the presence of tiotropium. No difference in the asthma control questionnaire at 80 mg propranolol was seen versus placebo in the presence of tiotropium. CONCLUSIONS Intravenous esmolol was administered without any adverse effects on pulmonary function in selected, stable, mild-to-moderate asthmatics controlled on inhaled corticosteroids. Tiotropium prevented propranolol induced bronchoconstriction after acute dosing during up-titration to 80 mg with no adverse impact on asthma control.
Collapse
Affiliation(s)
- Philip M Short
- Asthma and Allergy Research Group, Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, , Dundee, UK
| | | | | | | |
Collapse
|
43
|
Matera MG, Calzetta L, Cazzola M. β-Adrenoceptor Modulation in Chronic Obstructive Pulmonary Disease: Present and Future Perspectives. Drugs 2013; 73:1653-63. [DOI: 10.1007/s40265-013-0120-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
44
|
Kazani S, Israel E. What doesn't kill may not make you stronger. β-blockers for asthma. Am J Respir Crit Care Med 2013; 187:1281. [PMID: 23767898 DOI: 10.1164/rccm.201305-0815ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
45
|
Abstract
BACKGROUND AND AIM Recently, β-blockers have been suggested as a potential maintenance treatment option for asthma. The aim of this review is to provide an overview of the current knowledge of the potential benefits and risks of β-blocker therapy for asthma. METHOD Systematic literature review. RESULTS No significant increase in the number of patients requiring rescue oral corticosteroid for an exacerbation of asthma has been observed after initiation of β-blocker treatment. Patients with mild to moderate reactive airway disease, probably both asthma and chronic obstructive pulmonary disease, may have a limited fall in forced expiratory volume in 1 second (FEV1) following single-dose administration of β-blocker, whereas no change in FEV1 has been reported following long-term administration. In a murine model of asthma, long-term administration of β-blockers resulted in a decrease in airway hyperresponsiveness, suggesting an anti-inflammatory effect. In keeping with this, long-term administration of a nonselective β-blocker to steroid-naïve asthma patients has shown a dose-dependent improvement in airway hyperresponsiveness, and either an asymptomatic fall in FEV1 or no significant change in FEV1. Furthermore, available studies show that bronchoconstriction induced by inhaled methacholine is reversed by salbutamol in patients on regular therapy with a β-blocker. On the other hand, a recent placebo-controlled trial of propranolol and tiotropium bromide added to inhaled corticosteroids revealed no effect on airway hyperresponsiveness and a small, not statistically significant, fall in FEV1 in patients classified as having mild to moderate asthma. CONCLUSION The available, although limited, evidence suggests that a dose-escalating model of β-blocker therapy to patients with asthma is well tolerated, does not induce acute bronchoconstriction, and, not least, may have beneficial effects on airway inflammation and airway hyperresponsiveness in some patients with asthma. Further studies addressing the potential role of β-blocker therapy for asthma are clearly needed, but careful selection of the target population is warranted.
Collapse
Affiliation(s)
- Bente Arboe
- Department of Pulmonary Medicine, Hvidovre Hospital and University of Copenhagen, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Pulmonary Medicine, Hvidovre Hospital and University of Copenhagen, Hvidovre, Denmark
| |
Collapse
|