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Jacques MR, Kuhn BT, Albertson TE. Update on the pharmacological treatment of chronic obstructive pulmonary disease. Expert Opin Pharmacother 2024; 25:1903-1922. [PMID: 39344061 DOI: 10.1080/14656566.2024.2409322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 09/23/2024] [Indexed: 10/01/2024]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a common syndrome associated with smoking and environmental exposures coupled with genetic susceptibility. Recent major advancements in the treatment of COPD patients have become available. AREAS COVERED New data on the role of classic bronchodilators, including short-acting and long-acting beta2-agonists and anti-muscarinic antagonists, in the treatment of COPD patients are discussed. Data promoting a more targeted approach to inhaled and systemic corticosteroid use in COPD are reviewed. Phosphodiesterase (PDE) inhibitors, including the recently approved PDE 3/4 inhibitor inhaled ensifentrine, are noted. Selective use of antibiotics can play a role in complex COPD patients. COPD patients with evidence of asthma-COPD overlap syndrome and type-two lymphocytic inflammatory-mediated airway constriction appear to respond to biologics, particularly the anti-IL-4/IL-3 antagonist monoclonal antibody, dupilumab. EXPERT OPINION New therapeutic options have made the approach and treatment of the COPD patient much more complicated. These options tend to be very expensive. Attention to identifying the endotype and phenotype will help direct the pharmacotherapy.
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Affiliation(s)
- Madeleine R Jacques
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA, USA
| | - Brooks T Kuhn
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, UC Davis, School of Medicine, Sacramento, CA, USA
- Department of Internal Medicine, Department of Veterans Affairs, VA Northern California, Mather, CA, USA
| | - Timothy E Albertson
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, UC Davis, School of Medicine, Sacramento, CA, USA
- Department of Internal Medicine, Department of Veterans Affairs, VA Northern California, Mather, CA, USA
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Beng H, Hu J, Wang S, Liang X, Qin H, Tan W. Effects of R-salbutamol on the inflammatory response and acute lung injury in endotoxemic mice. Int Immunopharmacol 2023; 121:110482. [PMID: 37364330 DOI: 10.1016/j.intimp.2023.110482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
Salbutamol, which consists of an R-isomer and S-isomer, is an effective and widely used β2 adrenoreceptor agonist that may possess anti-inflammatory properties in addition to its bronchodilator activity. Whether the salbutamol R-isomer has advantages over its racemic mixture and effectiveness in treating endotoxemia and endotoxin-induced lung injury has not been well studied. In this study, we investigated the preventive and therapeutic effects of R-salbutamol (R-sal), S-salbutamol (S-sal), and their racemic mixture (Rac-sal) on a mouse model of lipopolysaccharide (LPS)-induced endotoxemia. Dexamethasone (Dex) was used for comparison. The results showed that R-sal markedly improved the 7-day survival rate of endotoxic mice when administered before and after LPS treatment. Dex was toxic and accelerated the death of endotoxic mice when administered before LPS injection. Histological examination of the lungs revealed that the LPS challenge resulted in acute lung damage, including inflammatory cell infiltration, thickened alveolar septa, and congestion. R-sal pre-treatment effectively inhibited these changes, accompanied by markedly reduced lung myeloperoxidase levels, serum cytokine levels, and lactate release, significant restoration of lymphocyte count, and reduction of monocyte count. This may have occurred through inhibition of M1 macrophage inflammatory responses by enhancement of β-arrestin2 expression and suppression of NF-κB activation. Rac-sal exhibited diminished effects compared to that of R-sal, while S-sal showed enhanced release of some inflammatory cytokines. In addition, R-sal pre-treatment showed a better improvement in prognostic pulmonary function on day 4 compared to that by Rac-sal. Collectively, our results indicate the potential benefits of R-sal in regulating inflammatory responses to endotoxemia and endotoxin-induced lung injury.
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Affiliation(s)
- Huimin Beng
- Post-Doctoral Innovation Site, Jinan University Affiliation, Yuanzhi Health-tech Inc., Hengqin District, Zhuhai 519000, Guangdong, China; Kesi (Shandong) Innovation Service Inc., heze modern medical port, Mudan district, Heze 274009, Shandong, China; Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Junhua Hu
- Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Shanping Wang
- Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Xinglong Liang
- Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Haolong Qin
- Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Wen Tan
- Post-Doctoral Innovation Site, Jinan University Affiliation, Yuanzhi Health-tech Inc., Hengqin District, Zhuhai 519000, Guangdong, China; Kesi (Shandong) Innovation Service Inc., heze modern medical port, Mudan district, Heze 274009, Shandong, China; Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia.
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