Chronic obstructive pulmonary disease bronchodilators

The first commercially available DPI system appeared on the market in 1949, developed and marketed by Abbott under the name Aerohaler. Like all early pulmonary drug-delivery devices, it delivered small-molecule compoimds (bronchodilators or inhaled corticosteroids) to the airways (not necessarily the deep limg) for the treatment of asthma or chronic obstructive pulmonary disease. Table 6 lists some of the early DPI systems used for asthma and COPD the energy somces in these devices were mechanical and patient inspiration. 

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

Bronchospasm (solution and aerosol) Used alone or in combination with other bronchodilators (especially beta-adrenergics) as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. 

Ipratropium has been used concomitantly with other drugs, including beta-adrenergic bronchodilators, sympathomimetic bronchodilators, methyixanthines, steroids, commonly used in the treatment of chronic obstructive pulmonary disease, without adverse drug reactions. 

Bronchospasm Use in patients with chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator who continue to have evidence of bronchospasm and require a second bronchodilator. 

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... 

Fatal Aspergillus myocarditis, probably related to shortterm administration of glucocorticoids, has been described in a 58-year-old man, who had an acute exacerbation of his chronic obstructive pulmonary disease and received oxygen, bronchodilators, omeprazole, co-amoxiclav, and intravenous methylprednisolone 40 mg 8-hourly he died 5 days later and postmortem examination showed a fungal myocarditis (337). 

Ram FS, Brocklebank DM, Muers M, et al. Pressurised metered-dose inhalers versus all other handheld inhalers devices to deliver bronchodilators for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2002 CD002170. 

Somand H, Remington TL. Tiotropium a bronchodilator for chronic obstructive pulmonary disease. Ann Pharmacother. 2005 39 1467-1475. 

Tashkin DP. Is a long-acting inhaled bronchodilator the first agent to use in stable chronic obstructive pulmonary disease Curr Opin Pulm Med. 2005 11 121-128. 

Ipratropium is a QTA produced by N-alkylation (iso-propyl) of hyoscyamine (Fig. 1). When inhaled as aerosolized agent it is a short-acting (3-6 h) antimusca-rinic especially on MR subtypes Ml-3 present in the lung. Therefore, it is clinically used as bronchodilator, antiasthmatic and drug for chronic obstructive pulmonary disease (COPD) [31, 33], Ipratropium is part of the WHO list of essential medicines [41],... 

Aminophylline is used in the treatment of asthma (as a bronchodilator) and in chronic obstructive pulmonary disease. In acute bronchospasm, aminophylline should not be given by the intravenous route the oral route is preferred. Parenteral administration can cause pain and is not recommended. Aminophylline is used as a cosmetic to remove fat from the thigh.45... 

In the respiratory tract, ipratropium s is a useful bronchodilator in chronic obstructive pulmonary disease and acute asthma. 

A number of patients who have persistent airflow obstruction exhibit considerable variation in airways resistance and hence in their benefit from bronchodilators drugs for asthma. It is important to recognise the coexistence of asthma with chronic obstructive pulmonary disease in some patients, and to assess their responses to bronchodilators or glucocorticoids over a period of time (as formal tests of respiratory function may not reliably predict clinical response in this setting). 

Nebulizers are generally used to treat acute exacerbations of asthma or chronic obstructive pulmonary disease. Other indications include long-term bronchodilator treatment of chronic airflow obstruction prophylactic treatment for asthma antimicrobial drugs for cystic fibrosis, bronchiectasis, and HIV/AIDS and symptomatic relief in palliative care. 

Cazzola M, Matera MG, Di Perna F, Calderaro F, Califano C, Vinciguerra A. A comparison of bronchodilating effects of salmeterol and oxitropium bromide in stable chronic obstructive pulmonary disease. Respir Med 1998 92(2) 354-7. 

Salmeterol 42 micrograms bd has been compared with inhaled ipratropium bromide 36 micrograms/day and inhaled placebo in a randomized, double-blind study for 12 weeks in 405 patients with chronic obstructive pulmonary disease (6). Both salmeterol and ipratropium bromide significantly increased the peak expiratory flow rate compared with placebo. Non-specific ear, nose, and throat symptoms (for example sore throat and upper respiratory tract infections) were more common with salmeterol and ipratropium than placebo. There were no significant differences between the groups in the total number of ventricular and supraventricular extra beats. There was no tolerance to the bronchodilating effects of salmeterol. 

Chronic obstructive pulmonary disease is a respiratory condition characterized by irreversible airway obstruction caused by chronic bronchitis or emphysema. The major symptoms of COPD include chronic cough, increased sputum production, and dyspnea. The vast majority of patients with COPD are those who are current or former heavy smokers. Other risk factors for the development of COPD include occupational exposure (dusts, chemicals) and rare genetic disorders (a -antitrypsin deficiency). The medical management of COPD includes pharmacotherapy (bronchodilators, corticosteroids, and antibiotics) in combination with interventions to reduce risk factors for disease progression (e.g., smoking cessation). Some patients require long-term administration of supplemental oxygen. 

Pierson DJ, Hudson LD, Stark K, Hedgecock M. Cardiopulmonary effects of terbutaline and a bronchodilator combination in chronic obstructive pulmonary disease. Chest 1980 77(2) 176-182. 

Acetylcysteine (Mucomyst) Acetylcysteine is the expectorant prescribed for chronic obstructive pulmonary disease. Acetylcysteine is administered by nebulizer 5 minutes after bronchodilators are administered. Acetylcysteine should not be mixed with other medication. Acetylcysteine is also an antidote for acetaminophen overdose if given within 12 to 24 hours after the overdose. 

This discussion includes two topics (1) delivery of bronchodilators and glucocorticoids to patients with asthma and chronic obstructive pulmonary diseases (COPD) and (2) aerosols for the treatment of cystic fibrosis (CF). 

Reversible airway obstruction is common in asthma and chronic obstructive pulmonary disease (COPD). An increase in FEVi after an inhaled/f-agonist of 12% and greater than 0.2 L suggests an acute bronchodilator response. 

Ikeda A, Nishimura K, Koyama H, et al. Comparison of the bronchodilator effects of salbutamol delivered via a metered-dose inhaler with spacer, a dry-powder inhaler, and a jet nebulizer in patients with chronic obstructive pulmonary disease. Respiration 1999 66 119-123. 

Friedman M. A multicenter study of nebulized bronchodilator solutions in chronic obstructive pulmonary disease. Am J Med 1996 100(suppl 1A) 30S-39S. 

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