Positioning new pharmacotherapies for COPD

Abstract

COPD imposes considerable worldwide burden in terms of morbidity and mortality. In recognition of this, there is now extensive focus on early diagnosis, secondary prevention, and optimizing medical management of the disease. While established guidelines recognize different grades of disease severity and offer a structured basis for disease management based on symptoms and risk, it is becoming increasingly evident that COPD is a condition characterized by many phenotypes and its control in a single patient may require clinicians to have access to a broader spectrum of pharmacotherapies. This review summarizes recent developments in COPD management and compares established pharmacotherapy with new and emerging pharmacotherapies including long-acting muscarinic antagonists, long-acting β-2 sympathomimetic agonists, and fixed-dose combinations of long-acting muscarinic antagonists and long-acting β-2 sympathomimetic agonists as well as inhaled cortiocosteroids, phosphodiesterase inhibitors, and targeted anti-inflammatory drugs. We also review the available oral medications and new agents with novel mechanisms of action in early stages of development. With several new pharmacological agents intended for the management of COPD, it is our goal to familiarize potential prescribers with evidence relating to the efficacy and safety of new medications and to suggest circumstances in which these therapies could be most useful.

Keywords:

• COPD phenotypes
• once-daily inhalers
• fixed-combination inhalers
• long-acting muscarinic antagonist
• LAMA
• long-acting β-2 sympathomimetic agonist
• LABA

Disclosure

IZB has received research contracts from GlaxoSmithKline and participated in research studies sponsored by Spiration and Amgen. CBC has received research contracts from Amgen, Boehringer Ingelheim, GlaxoSmithKline, and Spiration; honoraria for lecturing from Astra-Zeneca, Boehringer Ingelheim, Forest, GlaxoSmithKline, and Sunovion; and consultant fees from Boehringer Ingelheim, eResearch Technology, Forest, GlaxoSmithKline, PulmonX, Spiration, and Sunovion. AFA reports no conflicts of interest in this work.