Treatment Of Obstructive Pulmonary Disease Research Articles

A Concise Overview on Recent Advances in Pharmaceutical Aerosols and their Commercial Applications

Background: Localized drug delivery to the respiratory system has become an increasingly successful and essential treatment strategy for several pulmonary diseases, including asthma, chronic abstractive disease, pneumonia, bronchitis, and cystic fibrosis. The rising incidence of respiratory diseases is a significant factor driving the worldwide market for respiratory inhaler devices. Objective: The objective of this article is to present various aspects of pharmaceutical aerosols, including their types, components, fundamentals, in-process and finished product quality control tests based on pharmacopeial standards and specifications, and commercial utility considering the pharmaceutical aerosol dosage forms that have been patented from 2000 to 2020, along with a list of marketed pharmaceutical products. Method: Aerosol, collectively referred to as a pressurized device, operates by triggering an appropriate valve system with a continuous or metered dosage of tiny mist spray. It is used not only in the treatment of asthma and chronic obstructive pulmonary disease but also in the treatment of cancer, diabetes, migraine, angina pectoris, acute lung injury, bone disorders, tuberculosis, and many more. A multitude of different variables, including types and properties of propellants, active substances, containers, valves, actuators, spray patterns, valve crimping efficiency, and particle size of the aerosols, influence the therapeutic effectiveness of pharmaceutical aerosols. Conclusion: Based on the current findings, distinct characteristics such as the elimination of firstpass metabolism, quick drug absorption, ease of therapy termination, as well as a larger surface area have attributed to the success of pharmaceutical aerosols.

The PDE4 Inhibitor Tanimilast Restrains the Tissue-Damaging Properties of Human Neutrophils.

Neutrophils, the most abundant subset of leukocytes in the blood, play a pivotal role in host response against invading pathogens. However, in respiratory diseases, excessive infiltration and activation of neutrophils can lead to tissue damage. Tanimilast-international non-proprietary name of CHF6001—is a novel inhaled phosphodiesterase 4 (PDE4) inhibitor in advanced clinical development for the treatment of chronic obstructive pulmonary disease (COPD), a chronic inflammatory lung disease where neutrophilic inflammation plays a key pathological role. Human neutrophils from healthy donors were exposed to pro-inflammatory stimuli in the presence or absence of tanimilast and budesonide—a typical inhaled corticosteroid drug-to investigate the modulation of effector functions including adherence to endothelial cells, granule protein exocytosis, release of extracellular DNA traps, cytokine secretion, and cell survival. Tanimilast significantly decreased neutrophil-endothelium adhesion, degranulation, extracellular DNA traps casting, and cytokine secretion. In contrast, it promoted neutrophil survival by decreasing both spontaneous apoptosis and cell death in the presence of pro-survival factors. The present work suggests that tanimilast can alleviate the severe tissue damage caused by massive recruitment and activation of neutrophils in inflammatory diseases such as COPD.

Features and significance of the early bronchodilatation effect of the first dose of a long-acting bronchodilator alone and in fixed combination in the treatment of chronic obstructive pulmonary disease

The early bronchodilatory effects of the first dose of long-acting anticholinergics (glycopyrronium and tiotropium) were compared with those of a fixed double combination of long-acting bronchodilators of various classes (indacaterol/glycopyrronium) in patients with stable chronic obstructive pulmonary disease. The possibility of using the results of an early bronchodilatory response to predict their effectiveness in the basic therapy of chronic obstructive pulmonary disease is evaluated. A total of 176 patients with chronic obstructive pulmonary disease were examined. The patients were randomized into three groups. The first group (n = 66) took glycopyrronium, the second group (n = 60) received a combination of indacaterol/glycopyrronium, and the third group (n = 50, control) took tiotropium. Broncholytic tests with the listed drugs were evaluated. The early bronchodilatory effect of the first dose of 110/50 mcg indacaterol/glycopyrronium was manifested by significant bronchodilation (p 0.001) from 30 min, reached its maximum value 60 min after drug intake, and persisted after a 28-day course of treatment. The combination of indacaterol/glycopyrronium provided rapid and prolonged bronchodilation in patients with stable chronic obstructive pulmonary disease, demonstrating advantages over the isolated use of glycopyrronium and tiotropium. Maximization of bronchodilation by the sequential use of glycopyrronium and salbutamol leads to an increase in the volume of forced exhalation in the first second on the 90th min, comparable with the results of indacaterol/glycopyrronium on the 60th min after drug intake, which indicates the clinical feasibility of maximizing bronchodilation with drugs both separately and in combination. Based on a direct positive correlation between the initial value of the forced expiratory volume in the first second and the value on day 28 of indacaterol/glycopyrronium therapy, an equation for predicting the individual effectiveness of the drug during treatment is derived.

New insights into the optimal management of COPD: extracts from CHEST 2021 annual meeting (October 17–20, 2021)

ABSTRACT Introduction Discordance between real-world prescribing patterns and global treatment guidelines for the treatment of chronic obstructive pulmonary disease (COPD) with inhaled single or dual long-acting bronchodilator maintenance therapy is increasingly being reported in the literature, particularly with regard to addition of inhaled corticosteroids (ICS). Patient-related factors, e.g. inhalation technique and inspiratory flow, are key to disease control in COPD. Treatment discordance and patient-related factors can lead to high-cost side effects and sub-optimal treatment benefit; furthermore, the COVID-19 pandemic has led to new challenges in COPD management. Areas Covered This article summarizes a series of presentations sponsored by Boehringer Ingelheim and delivered at the annual CHEST congress 2021 (October 17–20, 2021) that explored new insights into the optimal management of COPD. Expert Opinion/Commentary There is a concerning high degree of discordance with GOLD recommendations. Dual therapy without addition of ICS does not increase exacerbation risk and could reduce pneumonia risk, and unnecessary prescription of triple therapy has financial implications. Clinic-based spirometry may not reflect the home setting, and training is required; inhalers that operate independently of users’ inhalation profiles should be considered. Integration of digital healthcare solutions into clinical studies is suggested in the post-COVID setting, although further evaluation is required.

Efficacy and Safety of Re Du Ning Injection for Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Background Re Du Ning, a traditional Chinese medicine injection, has been widely used for the treatment of chronic obstructive pulmonary disease, although without established systematic review evidence. This systematic review aimed to assess the efficacy and safety of Re Du Ning in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods We searched seven databases (PubMed, Embase, the Cochrane Library, SinoMed, CNKI, WanFang, and the Chinese Clinical Trial Registry) up to November 1, 2021, to identify randomized controlled trials of Re Du Ning for AECOPD. Two researchers independently carried out literature screening and data extraction. Effects were measured by risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). The meta-analysis was completed by RevMan 5.4 software. Results Twenty-six studies met the eligibility criteria, with a total of 2284 patients. The findings of the meta-analysis indicated that the response rate of the experimental group was higher than that of the control group: RR = 1.14% and 95% CI: (1.09, 1.19). Significantly greater improvements in pulmonary function: FEV1: MD = 0.28 L, 95% CI: (0.20, 0.36); FEV1/FVC: MD = 8.63%, 95% CI: (4.68, 12.59); T-lymphocyte counts: CD4: MD = 6%, 95% CI: (2.44, 9.56); CD3: MD = 10.42%, 95% CI: (8.6, 12.24); CD4/CD8: MD = 0.38%, 95% CI: (0.32, 0.43); acid/base imbalance: PH: MD = 0.05, 95% CI: (0.01, 0.10); PaO2: MD = 9.02 mmHg, 95% CI: (11.11, 0.10), p=0.005; C-reactive protein: MD = −6.65 mg/L, 95% CI: (−10.97, −2.34); and PCT: MD = −0.28 μg/L, 95% (CI: −0.41, −0.15) were observed in patients receiving Re Du Ning compared with those receiving the control treatment. Re Du Ning did not significantly change the carbon dioxide partial pressure. All reported adverse reactions were mild. Conclusion Re Du Ning injection, as a complementary therapy to routine treatment, has better efficacy than Western medicine alone in relieving clinical symptoms, delaying pulmonary function decline, and improving inflammation indicators for AECOPD, with good safety. The evidence was limited by a lack of high-quality RCTs.

Efficacy of perindopril/amlodipine and valsartan/amlodipine combinations in patients with a combination of arterial hypertension and chronic obstructive pulmonary disease

Objective: to study the comparative efficacy and safety of the use of perindopril/amlodipine and valsartan/amlodipine combinations in patients with a combination of arterial hypertension and chronic obstructive pulmonary disease. Materials and methods: 85 patients with a verified diagnosis of arterial hypertension and chronic obstructive pulmonary disease were examined, the average age of patients was 60.9±1.1 years; 54% of men and 46% of women who were prescribed two variants of combination therapy (group A amlodipine/perindopril, group B amlodipine/valsartan). At the first visit and 6 weeks after the start of therapy, all patients underwent clinical, laboratory and instrumental examinations in accordance with the current protocols for the treatment of hypertension and chronic obstructive pulmonary disease, a daily blood pressure study, the frequency of depressive disorders was assessed on the Beck scale and the quality of life according to the SF-36 questionnaire. Results: the use of both antihypertensive regimens in comorbid patients was accompanied by comparable antihypertensive efficacy of therapy, contributed to the same statistically significant decrease in daily, day and night blood pressure indicators. The analysis of the indicators of the function of external respiration revealed the absence of negative dynamics of spirographic indicators in both groups. The use of both combinations of antihypertensive drugs contributed to the statistically identical recovery of both physical and mental components of the patient's quality of life. The improvement in the quality of life of comorbid patients was accompanied by a decrease in the manifestations of depressive disorders in the studied patients according to the Beck scale. The average score of the Beck scale in patients of group A before treatment was 11.6±0.97, against the background of therapy — 9.1±0.77, p <0.001. In patients of group B, it decreased from 13.0±1.06 to 9.3±0.78, p <0.001. Conclusion: the use of antihypertensive combined strategies amlodipine / perindopril and amlodipine / valsartan for the treatment of hypertension in patients with chronic obstructive pulmonary disease is characterized by comparable effectiveness of blood pressure control, which is confirmed by the data of daily monitoring of blood pressure. Effective control of blood pressure was accompanied by statistically significant (p<0.001) positive dynamics of most indicators of the quality of life of patients in both study groups and the severity of manifestations of depression. Any of the studied combinations, which demonstrated comparable efficacy and tolerability in the study, can be recommended as the first step of antihypertensive therapy in patients with arterial hypertension in combination with chronic obstructive pulmonary disease.

NEW POSSIBILITIES FOR MODIFYING THE COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: THE EFFECT OF TIOTROPIUM BROMIDE ON CERTAIN PATHOGENETIC LINKS OF NEOCOLLAGENOGENESIS AND LOCAL IMMUNE DEFENCE OF THE BRONCHIAL TREE

The aim: To evaluate the dynamics of the interferon and collagen-IV systems in bronchoalveolar lavage in the treatment of chronic obstructive pulmonary disease using the tiotropium bromide medication. Materials and methods: The study involved 60 COPD patients with bronchial obstruction of the II degree before and on days 30 and 60 of therapy using conventional treatment regimens and inhalations of tiotropium bromide a the dose of 18 mcg once a day. The collagen-IV levels in bronchoalveolar fluid were determined by means of enzyme-linked immunoassay using “StatFax 303 Plus” analyzer and “Biotrin Collagen IV EIA” reagents. The level of IFN-γ was identified with the help of enzyme-linked immunoassay using “StatFax 303 Plus” analyzer and “ProKon” reagents (LLC “Protein Contour”, Russia) in bronchoalveolar fluid obtained during fiber-optic bronchoscopy. Results: When examining Group I patients on the 30th day we found out that the content of collagen-IV in the bronchoalveolar fluid had decreased by only 10.29% (p <0.05). Detection of collagen-IV indices in Group II patients on the 30th day of tiotropium bromide use showed the 29.43% (p <0.05) decrease in its content as compared to the initial indices. In Group III patients, the concentration of collagen-IV had a maximum tendency to normalize and made up (24.72 ± 1.15) ng/ml, and decreased by 2.44 times (p <0.05) as compared to the initial indices. Our examination of 12 patients from the comparison group I on the 60th day of treatment revealed even a slight increase in the content of collagen-IV in the bronchoalveolar fluid, as compared with the data obtained on the 30th day. The identified IFN-γ deficiency is indicative for the COPD of the II degree of bronchial obstruction, and its indices were 2.29 times lower than those observed in people from the control group. On day 30, we found out that the content of IFN-γ in Group I patients increased by only 10.29% (p>0.05). Detection of IFN-γ in Group II patients showed 42.27% (p<0,05) increase in its content as compared to the initial indices. The most favorable dynamics of IFN-γ levels in bronchoalveolar contents was observed in Group III patients, and at the time of observation it made up (1.16 ± 0.08) pg/ml, having 2 times (p<0.05) increased as compared to the initial indices. However, in contrast to those taking tiotropium bromide, we examined 12 patients from Group I on the 60th day of treatment and found no significant positive dynamics of IFN-γ content in bronchoalveolar fluid as compared to the indices obtained on day 30. Conclusions: The obtained findings indicate the effect of tiotropium bromide on the reduction of interferon-γ and reduce of collagen-IV levels, which depend on the duration of its use.

Assessment of Extrafine Beclomethasone/Formoterol for the Treatment of Chronic Obstructive Pulmonary Disease: A Non-Interventional Study in a Bulgarian Population

Assessment of Extrafine Beclomethasone/Formoterol for the Treatment of Chronic Obstructive Pulmonary Disease: A Non-Interventional Study in a Bulgarian Population

Seven Ferroptosis Specific Expressed Genes are Considered as the Potential Biomarkers for the Diagnosis and Treatment of Cigarette Smoke-Induced Chronic Obstructive Pulmonary Disease

Seven Ferroptosis Specific Expressed Genes are Considered as the Potential Biomarkers for the Diagnosis and Treatment of Cigarette Smoke-Induced Chronic Obstructive Pulmonary Disease

Clinical Observation of Moxifloxacin Combined with Levofloxacin in the Treatment of Chronic Obstructive Pulmonary Disease

Clinical Observation of Moxifloxacin Combined with Levofloxacin in the Treatment of Chronic Obstructive Pulmonary Disease

Study of Glucocorticoid Combined with Terbutaline in the Treatment of Chronic Obstructive Pulmonary Disease

Study of Glucocorticoid Combined with Terbutaline in the Treatment of Chronic Obstructive Pulmonary Disease

Effect of Low Dose Methylprednisolone Combined with Respiratory Stimulant in the Treatment of Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

Effect of Low Dose Methylprednisolone Combined with Respiratory Stimulant in the Treatment of Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

Extracorporeal carbon dioxide removal for treatment of exacerbated chronic obstructive pulmonary disease (ORION): study protocol for a randomised controlled trial

BackgroundHypercapnic exacerbations are severe complications of chronic obstructive pulmonary disease (COPD), characterized by negative impact on prognosis, quality of life and healthcare costs. The present standard of care for acute exacerbations of COPD is non-invasive ventilation; when it fails, the use of invasive mechanical ventilation is inevitable, but is associated with extremely poor prognosis. Extracorporeal circuits designed to remove CO2 (ECCO2R) may enhance the efficacy of NIV to remove CO2 and avoid the worsening of respiratory acidosis, which inevitably leads to failure of non-invasive ventilation. Although the use of ECCO2R for acute exacerbations of COPD is steadily increasing, solid evidence on its efficacy and safety is scarce, thus the need for a randomized controlled trial.Methodsmulticenter randomized controlled unblinded clinical trial including 284 (142 per arm) patients with acute hypercapnic respiratory failure caused by exacerbation of COPD, requiring respiratory support with NIV. The primary outcome is event free survival at 28 days, a composite outcome defined by survival in absence of prolonged mechanical ventilation, severe hypoxemia, septic shock and second episode of COPD exacerbation. Secondary outcomes are incidence of endotracheal intubation and tracheostomy, intensive care and hospital length-of-stay and 90-day mortality.DiscussionAcute exacerbations of COPD represent a significant burden in terms of prognosis, quality of life and healthcare costs. Lack definite evidence despite increasing use of ECCO2R justifies a randomized trial to evaluate whether patients with acute hypercapnic acidosis not responsive to NIV should undergo invasive mechanical ventilation (with all serious related risks) or be treated with ECCO2R to avoid invasive ventilation but be exposed to possible adverse events of ECCO2R. Owing to its pragmatic nature, sample size and composite primary outcome, this trial aims at providing valuable answers to relevant questions for clinical treatment of acute exacerbations of COPD.Trial registrationClinicalTrials.gov, NCT04582799. Registered 12 October 2020, .

Combination antibiotic therapy versus monotherapy in the treatment of acute exacerbations of chronic obstructive pulmonary disease: an open-label randomized trial

BackgroundThe role of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and their effectiveness in combination have not been clearly established. To determine whether using a combination of fluoroquinolones and beta-lactams improves the clinical and microbiological efficacy of antibiotics on day 20 of treatment, we conducted an open-label randomized trial based on clinical outcomes, microbiological clearance, spirometry tests, and signs of systemic inflammation in patients hospitalized with acute exacerbations of COPD.MethodsWe enrolled 139 subjects with COPD exacerbations, defined as acute worsening of respiratory symptoms leading to additional treatment. Patients were divided randomly into two groups: 79 patients using beta-lactam antibiotics alone and 60 using beta-lactam antibiotics plus fluoroquinolones. Clinical and microbiological responses, spirometry tests, symptom scores, and serum C-reactive protein (CRP) levels were evaluated.ResultsClinical success, lung function, and symptoms were similar in patients with or without fluoroquinolone administration on days 10 and 20. Combination therapy was superior in terms of microbiological outcomes and reduction in serum CRP value. Although equivalent to monotherapy in terms of clinical success, the combination showed superiority in terms of microbiological success and a decrease in CRP. The combination therapy group had a higher microbiological success rate with gram-negative bacteria than the monotherapy group with Pseudomonas aeruginosa (100% vs. 33.3%, respectively) and Acinetobacter baumanii (100% vs. 20%, respectively) (P < 0.05).ConclusionsConcomitant use of fluoroquinolone and beta-lactam antibiotics for bacterial infections during COPD exacerbations caused by gram-negative bacteria appear to be effective and should be applied in clinical practice.

Clinical Efficacy of Doxotheophylline and Theophylline in the Treatment of Moderate Stable Chronic Obstructive Pulmonary Disease

Clinical Efficacy of Doxotheophylline and Theophylline in the Treatment of Moderate Stable Chronic Obstructive Pulmonary Disease

Nursing Experience of Non-invasive Ventilator in the Treatment of Chronic Obstructive Pulmonary Disease with Severe Respiratory Failure

Nursing Experience of Non-invasive Ventilator in the Treatment of Chronic Obstructive Pulmonary Disease with Severe Respiratory Failure

Nursing Analysis of Noninvasive Ventilation in the Treatment of Elderly Chronic Obstructive Pulmonary Disease Combined with Severe Respiratory Failure

Nursing Analysis of Noninvasive Ventilation in the Treatment of Elderly Chronic Obstructive Pulmonary Disease Combined with Severe Respiratory Failure

Urinary incontinence associated with pharmacological treatment of Chronic Obstructive Lung Disease: An integrative review

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease, often associated with smoking. COPD patients have persistent, including urinary incontinence. Therefore, a research has the general objective of knowing the physiological mechanism of urinary incontinence associated with the pharmacological treatment of COPD. As a methodological process, this study is an integrative review that included randomized clinical trials, quasi-experimental intervention studies, cohort and case-control. The selection of studies was carried out in the databases PubMed, SciELO, Science Direct and BVS (Virtual Health Library), published between 2010 and July 2020, in Portuguese and English. Pharmacological classes SABA, LABA, SAMA, LAMA, ICS and iPDE4 were considered to investigate adverse effects and check for the presence of urinary symptoms caused by these drugs. In the results and discussion, 113 articles were identified with the investigated descriptors. After the article selection process, 14 studies resulted: PubMED (13); and Science Direct (1). The pharmacological class related to urinary incontinence identified in this study was that of anticholinergics / antimuscarinics. From this perspective, it can be considered that Urinary Incontinence has a low relationship with the adverse effects of drugs for the treatment of Chronic Obstructive Pulmonary Disease (COPD). However, as urinary incontinence is not considered a life-threatening problem, it is possible that it has not been included among the adverse events to be explored.

The Effect of Sanzi Yangqin Decoction Combined with Maxing Ganshi Decoction on Syndrome Differentiation and Treatment of Chronic Obstructive Pulmonary Disease with Phlegm and Heat Blocking the Lung

The Effect of Sanzi Yangqin Decoction Combined with Maxing Ganshi Decoction on Syndrome Differentiation and Treatment of Chronic Obstructive Pulmonary Disease with Phlegm and Heat Blocking the Lung

Quantitative Spectrophotometric Estimation of Prednisolone in Tablet Dosage Form Using Eco-friendly Green Solvent and by applying Beer-Lambert’s Law Mathematical Equation Method

Prednisolone is a widely used synthetic glucocorticoid drug used in the treatment of allergies, inflammatory conditions, auto-immune disorders, acute and chronic obstructive pulmonary disease, rheumatoid arthritis, systemic lupus erythematosus, dermatitis, eye inflammation, asthma and multiple sclerosis. A simple and economical method was developed using eco-friendly green solvent. In this developed method the eco-friendly green solvent used was ethanol which is available easily. The method was projected to quantitative estimation and assay of Prednisolone in Prednisolone dispersible tablet dosage form. The amount and percent label claim of Prednisolone in tablet dosage form was estimated using Beer-Lambert’s law. Specific absorbance (A1%1cm) of Prednisolone is 415 at lambda max of 243 nm. The method developed was validated as per ICH guidelines. The proposed method was found to be simple, accurate, sensitive, precise, linear and rugged. The method obeys Beer-Lambert’s Law in the concentration range of 2.5-20μg/mL, as the r2 value was found to be 1.000. The mean percent recovery was found to be within acceptable range as per ICH guidelines. Hence the developed method can be used in regular quantitative analysis. The developed method acquires only one green solvent, low cost analytical equipment and the percent label claim can be calculated in the assay of Prednisolone tablets without using any standards solution or standard graph by just employing specific absorbance value in Beer-Lambert’s law, thereby concentration of drug can be calculated. As this method is simple, economical and eco-friendly it can be used elegantly and routinely in analytical laboratories and industries for estimation of Prednisolone in tablet formulation.