1,721,030 research outputs found
Comparative effectiveness of drugs for chronic obstructive pulmonary disease.
No full textCurrent guidelines for the management of chronic obstructive pulmonary disease (COPD) recommend the use of inhaled long-acting bronchodilators, inhaled corticosteroids (ICSs) and their combinations for maintenance treatment of moderate to severe COPD. However, doctors still wonder if in patients with mild/moderate stable COPD it is best to start with a β-adrenoceptor agonist or an antimuscarinic agent. They also wonder if once- or twice-daily dosing is preferable, and if it is enough to develop a novel therapy that is dosed once daily rather than twice daily if the agents are both equally safe and effective. It also remains unclear whether and when a second bronchodilator with a different mechanism of action should be used in patients with stable COPD and when, in its place, an ICS must be added, and also whether long-acting antimuscarinic agent (LAMA)/long-acting β-adrenoceptor agonist (LABA) combination therapy is preferred over LAMA plus LABA/ICS. Moreover, there is no solid evidence of the best way to administer a triple combination product: should drugs be delivered concomitantly or sequentially? In any case, the growing evidence that COPD is a heterogeneous disease with characteristics that occur with different phenotypes suggests that a specific therapy may not be ultimately identified for every phenotype. Therefore, there is a clear need to move toward personalized treatment in COPD because phenotypic heterogeneity may affect treatment response and the clinical course of the disease. Unfortunately, however, there is not enough money or time to examine the impact of each treatment step or combination of treatments in each specific phenotype using randomized controlled trials. Consequently, doctors wonder if there is a role for comparative effectiveness research (CER), which can be considered a subset of patient-oriented research that examines available therapeutic options in particular patients to determine relevant health outcomes. There is a strong agreement that carefully designed CER studies, which explicitly address treatment and population heterogeneity, will provide exciting opportunities to develop an evidence base for guiding decisions about how best to tailor care for individual patients with COPD. Copyright © 2012 Prous Science, S.A.U. or its licensors. All rights reserved
Novel bronchodilators in asthma.
No full textPURPOSE OF REVIEW: Because of the central role of bronchodilators in the treatment of asthma, in recent years there has been a renewed interest in the field and now once-daily bronchodilators are in development in an attempt to simplify their use.
RECENT FINDINGS: A variety of beta2-agonists with long half-lives, also called ultra long-acting beta2-agonists (ultra-LABAs; indacaterol, carmoterol, milveterol, GSK-642444, BI-1744-CL, LAS-100977, and PF-00610355) are currently under development with the hopes of achieving once-daily dosing. Between them, indacaterol, GSK-642444, and carmoterol are at a more advanced stage of development. Also several novel inhaled long-acting antimuscarinic agents are currently being developed, but their role in the treatment of asthma is limited. As combination therapy with an inhaled corticosteroid (ICS) and a LABA is considered the first-line approach for treating patients suffering from asthma, some novel once-daily combinations of LABAs and ICSs are under development.
SUMMARY: Bronchodilators are central in the symptomatic management of asthma. It is likely that the once-daily dosing of a bronchodilator would be a significant convenience and probably a compliance-enhancing advantage, leading to improved overall clinical outcomes in patients with asthma. In any case, as a LABA in combination with an ICS continues to be the most effective asthma treatment, once-daily combinations of ultra-LABAs and ICSs will be central in the treatment of asthmatic patients in the next year
Omalizumab: stepping outside our comfort zone to broaden the number of those who can benefit
No full textNew developments in the combination treatment of COPD: focus on umeclidinium/vilanterol
No full textMario Cazzola,1 Andrea Segreti,1 Maria Gabriella Matera2 1Department of System Medicine, University of Rome 'Tor Vergata', Rome, Italy; 2Department of Experimental Medicine, Second University, Naples, Italy Abstract: An increasing body of evidence suggests that the long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) combination appears to play an important role in maximizing bronchodilation, with studies to date indicating that combining different classes of bronchodilators may result in significantly greater improvements in lung function compared to the use of a single drug, and that these combinations are well tolerated in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). An inhaled, fixed-dose combination of two 24-hour bronchodilators, the LAMA umeclidinium and the LABA vilanterol, is under development as a once-daily treatment for COPD. The efficacy of both mono-components has already been demonstrated. The information currently available suggests that umeclidinium/vilanterol is an effective once-daily dual bronchodilator fixed-dose combination in the treatment of COPD. However, it remains to be seen if it compares favorably with current therapies. Moreover, the question remains whether umeclidinium/vilanterol fixed-dose combination, which significantly improves FEV1, is also associated with improvements in other outcome measures that are important to COPD patients. Keywords: muscarinic antagonist, dual bronchodilation, COP
New developments in the combination treatment of COPD: focus on umeclidinium/vilanterol
Full text linkAn increasing body of evidence suggests that the long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) combination appears to play an important role in maximizing bronchodilation, with studies to date indicating that combining different classes of bronchodilators may result in significantly greater improvements in lung function compared to the use of a single drug, and that these combinations are well tolerated in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). An inhaled, fixed-dose combination of two 24-hour bronchodilators, the LAMA umeclidinium and the LABA vilanterol, is under development as a once-daily treatment for COPD. The efficacy of both mono-components has already been demonstrated. The information currently available suggests that umeclidinium/vilanterol is an effective once-daily dual bronchodilator fixed-dose combination in the treatment of COPD. However, it remains to be seen if it compares favorably with current therapies. Moreover, the question remains whether umeclidinium/vilanterol fixed-dose combination, which significantly improves FEV1, is also associated with improvements in other outcome measures that are important to COPD patients
The clinical use of regenerative therapy in COPD
No full textRegenerative or stem cell therapy is an emerging field of treatment based on stimulation of endogenous resident stem cells or administration of exogenous stem cells to treat diseases or injury and to replace malfunctioning or damaged tissues. Current evidence suggests that in the lung, these cells may participate in tissue homeostasis and regeneration after injury. Animal and human studies have demonstrated that tissue-specific stem cells and bone marrow-derived cells contribute to lung tissue regeneration and protection, and thus administration of exogenous stem/progenitor cells or humoral factors responsible for the activation of endogenous stem/progenitor cells may be a potent next-generation therapy for chronic obstructive pulmonary disease. The use of bone marrow-derived stem cells could allow repairing and regenerate the damaged tissue present in chronic obstructive pulmonary disease by means of their engraftment into the lung. Another approach could be the stimulation of resident stem cells by means of humoral factors or photobiostimulation
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