Drugs for airway disease

Abstract

Drugs for obstructive airway diseases include relievers and controllers. Inhaled β2-agonists are the most effective bronchodilators. Short-acting inhaled β2-agonists are used for symptom relief, whereas long-acting inhaled β2-agonists may be added to inhaled corticosteroids if asthma control is poor in those taking low doses of inhaled corticosteroids and are conveniently taken as a fixed combination inhaler. Long-acting β2-agonists are also effective bronchodilators in chronic obstructive pulmonary disease (COPD). Inhaled anticholinergics are the bronchodilators of first choice in COPD and tiotropium once daily is preferred. Inhaled corticosteroids are the first-line controller treatment for chronic asthma, but are much less effective in COPD. Anti-leukotrienes may be used as an add-on therapy in patients with asthma that is not controlled by inhaled corticosteroids, but are less effective than adding a long-acting β2-agonist and the response is unpredictable. Theophylline is a useful add-on therapy in severe asthma and COPD. Anti-immunoglobulin E (anti-IgE) antibody (omalizumab) reduces exacerbations in patients with severe asthma not controlled by maximal does of inhaled therapy, but response is unpredictable and the treatment is very expensive. Roflumilast is an oral phosphodiesterase-4 inhibitor that may be added in patients with severe COPD and frequent exacerbations.