Chronic obstructive pulmonary disease 2-agonists

Johnson M (2004) Interactions between corticosteroids and beta2-agonists in asthma and chronic obstructive pulmonary disease. Proc Am Thorac Soc 1 200-6... 

Aerosolised medicines have been used for centuries to treat respiratory diseases, with inhalation therapy for the airways focused primarily on the treatment of asthma and chronic obstructive pulmonary disease (COPD). The development of new products for delivery to the lungs for these respiratory diseases includes new steroids and beta agonists plus combination products featuring both agents. New classes of anti-asthma medication are also being developed for inhalation with the aim of delivering them directly to the inflamed airways. 

Dougall, I.G., Young, A., Ince, F., and Jackson, D.M., Dual dopamine D2 receptor and / -adrenoceptor agonists for the treatment of chronic obstructive pulmonary disease the pre-clinical rationale, Resp. Med., 97, S3, 2003. 

Salbutamol is a beta-adrenoreceptor agonist that is used in asthma or chronic obstructive pulmonary disease in order to exert bronchodilation. Side-effects... 

Appleton S, Poole P, Smith B, Veale A, Lasserson TJ, Chan MM et al. Long-acting beta2-agonists for poorly reversible chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006. 

Cazzola M, Donner CF, Matera MG. Long acting beta2-agonists and theophylline in stable chronic obstructive pulmonary disease. Thorax 1999 54 730-6. 

Ipratropium bromide (Atrovent) is a quaternary amine derivative that is used via inhalation in the treatment of chronic obstructive pulmonary disease and to a lesser extent, asthma. Ipratropium has a slower onset of action (1-2 hours for peak activity) than Pz-adrenoceptor agonists and thus may be more suitable for prophylactic use. Compared with p2-adrenoceptor agonists, ipratropium is generally at least as effective in chronic obstructive pulmonary disease but less effective in asthma. 

Ipratropium has greater effectiveness than P2-adreno-ceptor agonists in two settings in psychogenic asthma and in patients taking Pj-adrenoceptor antagonists. A fixed combination of ipratropium and albuterol (Combivent) is approved for use in chronic obstructive pulmonary disease. 

Albuterol Selective B2 agonist Prompt, efficacious bronchodilation Asthma, chronic obstructive pulmonary disease (COPD) drug of choice in acute asthmatic bronchospasm Aerosol inhalation duration several hours also available for nebulizer and parenteral use Toxicity. Tremor, tachycardia t overdose arrhythmias... 

Van Schaick EA, Jacobson KA, Kim HO, IJzerman AP, Danhof M (1996) Hemodynamic effects and histamine release elicited by the selective adenosine A3 receptor agonist 2-Q-IB-MECA in conscious rats. Eur J Pharmacol 308(3) 311—314 Varani K, Caramori G, Vincenzi F, Adcock I, Casolari P, Leung E, Maclennan S, Gessi S, Morello S, Barnes PJ, Ito K, Chung KF, Cavallesco G, Azzena G, Papi A, Borea PA (2006) Alteration of adenosine receptors in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 173(4) 398-406... 

The mode of action of theophylline is different from that of Beta2-adrenergic agonists and anticholinergic agents, so it is still used in the treatment of selected patients with asthma or chronic obstructive pulmonary disease. 

Inhaled ipratropium [i pra TROE pee um], a quaternary derivative of atropine (see Figure 22.5, p. 220), is useful in treating asthma and chronic obstructive pulmonary disease in patients unable to take adrenergic agonists. Ipratropium is also used in the management of chronic obstructive pulmonary disease (see p. 222). Important characteristics of the muscarinic antagonists are summarized in Figure 5.6. 

The most serious side effect of the opioids is respiratory depression.The narcotic agonists suppress the brainstem respiratory centers and thus alter tidal volume, respiratory rate, rhythmicity, and responsiveness to CO2. When used in equianalgesic doses, the opioids, with the exception of pentazocine, produce similar degrees of respiratory depression.Therapeutic doses of opioid analgesics are unlikely to produce significant respiratory depression in most healthy patients.The opioids must be used with caution, however, in patients with preexisting pulmonary disease, especially patients with airway compromise such as chronic obstructive pulmonary disease. 

The efficacy of long-acting beta2-adrenoceptor agonists in patients with chronic obstructive pulmonary disease remains unclear, but their role in treatment regimens, particularly in comparison with oral theophylline, has been reviewed (1). 

Rennard SI, Anderson W, ZuWallack R, Broughton J, Bailey W, Friedman M, Wisniewski M, Rickard K. Use of a long-acting inhaled beta2-adrenergic agonist, salmeterol xinafoate, in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001 163(5) 1087-92. 

A Because CD is currently receiving amantadine for Parkinson s disease, he does not require additional prophylaxis with rimantadine because both medications are equally ef ive for the treatment and prophylaxis of influenza A. Zanamivir is unnecessary because he does not need additional prophylaxis for influenza B. In addition, zanamivir may cause bronchospasms in patients with asthma or chronic obstructive pulmonary disease. If CD requires zanamivir in the future, he should be instructed to use his beta-agonist inhaler prior to zanamivir. 

The combination of albuterol sulfate and ipratropium bromide is available commercially in a metered-dose inhaler device for humans. In human patients with chronic obstructive pulmonary disease, this anticholinergic p2 agonist combination provides more complete bronchodilatation than... 

Ammann V, Vrins A. Lavoie J 1998 Effects of inhaled beclomethasone dipropionate on respiratory function in horses with chronic obstructive pulmonary disease (CORD). Equine Veterinary Journal 30 152-157 Bailey J, Colahan P, Kubilis P et al 1999 Effect of inhaled beta2 adrenoceptor agonist, albuterol sulphate, on performance of horses. Equine Veterinary Journal Supplement 30 575-580... 

Asthma, Chronic obstructive pulmonary disease P2-Agonists Reduce bronchial smooth muscle tone Formeterol, Salbutamol, Salmeterol, Terbutaline... 

Ram FSF, Sestini P. Regular inhaled short acting p2 agonists for the management of stable chronic obstructive pulmonary disease Cochrane systematic review and meta-analysis. Thorax 2003 58 580-584. 

Indications Chronic obstructive pulmonary disease (COPD) Category Beta2-adreneric agonist Half-life 26 hours... 

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