ciclesonide and Pulmonary-Disease--Chronic-Obstructive

During the past decade, there has been increasing evidence that the small airways (ie, airways < 2 mm in internal diameter) contribute substantially to the pathophysiologic and clinical expression of asthma and COPD. The increased interest in small airways is, at least in part, a result of innovation in small-particle aerosol formulations that better target the distal lung and also advanced physiologic methods of assessing small airway responses. Increasing the precision of drug deposition may improve targeting of specific diseases or receptor locations, decrease airway drug exposure and adverse effects, and thereby increase the efficiency and effectiveness of inhaled drug delivery. The availability of small-particle aerosols of corticosteroids, bronchodilators, or their combination enables a higher total lung deposition and better peripheral lung penetration and provides added clinical benefit, compared with large-particle aerosol treatment. However, a number of questions remain unanswered about the pragmatic approach relevant for clinicians to consider the role of small airways directed therapy in the day-to-day management of asthma and COPD. We thus have tried to clarify the dilemmas, confusion, and misconceptions related to small airways directed therapy. To this end, we have reviewed all studies on small-particle aerosol therapy systematically to address the dilemmas, confusion, and misconceptions related to small airways directed therapy.

Topics: Administration, Inhalation; Asthma; Beclomethasone; Bronchioles; Bronchodilator Agents; Disease Management; Drug Combinations; Dry Powder Inhalers; Equipment Design; Fluocinolone Acetonide; Formoterol Fumarate; Glucocorticoids; Humans; Inhalation Spacers; Metered Dose Inhalers; Nebulizers and Vaporizers; Particle Size; Pregnenediones; Pressure; Pulmonary Disease, Chronic Obstructive

Inhaled corticosteroids (ICS) are the standard of care in asthma and are widely used in the treatment of patients with chronic obstructive pulmonary disease. High-dose regimens and long-term use of ICS in predisposed individuals may be associated with a variety of side effects, similar to those observed with systemic corticosteroid therapy. Side effects associated with long-term ICS use include reduction in growth velocity, cataracts, glaucoma, osteoporosis, and fractures. Fear of unwanted complications may be of concern in all patients using ICS, particularly in age- and gender-specific populations that are more prone to develop side effects or to reduce treatment adherence because of physical, behavioral, or psychological problems. In addition to concerns about ICS safety, dosing regimens that are difficult to follow may further reduce a patient's ability to comply with treatment. Ciclesonide, a new-generation ICS with unique pharmacokinetic properties, was developed to provide effective anti-inflammatory control for asthma with once-daily administration to improve patient adherence and a high safety profile to reduce the occurrence of local and systemic side effects.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Anti-Allergic Agents; Asthma; Humans; Models, Biological; Pregnenediones; Pulmonary Disease, Chronic Obstructive; Risk Assessment

Inhaled synthetic glucocorticosteroids are widely used in the treatment of bronchial asthma where they provide very effective first line treatment. However, a range of unwanted side effects and the often complex dosing schedules associated with these drugs frequently result in poor patient compliance. The soft drug approach has been utilised as a means of delivering these potent anti-inflammatory agents close to their site of action while reducing the degree of systemic exposure and thus limiting or eliminating the associated systemic and local side effects. A further target for pharmaceutical companies is to deliver these new treatments in a once daily formulation thus further enhancing patient compliance. While many soft steroids have failed to progress into the clinic two are meeting with some degree of success. Loteprednol etabonate, an inactive metabolite soft steroid, has been accepted for the treatment of ophthalmic disorders and is being examined in clinical trials for its effects on airway inflammation. Ciclesonide, a pro-drug soft steroid, has demonstrated efficacy without side effects in a once daily formulation in asthma patients and is being developed for the treatment of both asthma and chronic obstructive pulmonary disease with launches of a once daily inhaler formulation expected in 2003. These drugs may represent a significant step forward in the treatment of inflammatory diseases of the airways.

Topics: Androstadienes; Animals; Anti-Allergic Agents; Asthma; Clinical Trials as Topic; Glucocorticoids; Humans; Loteprednol Etabonate; Pregnenediones; Prodrugs; Pulmonary Disease, Chronic Obstructive

COPD is a chronic inflammatory disease characterized by partially reversible airflow limitation. Currently, phosphodiesterase4 inhibitors and inhaled corticosteroids are anti-inflammatory agents that can be used in patients with severe COPD, always added to at least one bronchodilator. In this prospective interventional pilot study, we investigated the effect of adding oral roflumilast 500 μg once-daily or inhaled ciclesonide 160 μg once-daily to glycopyrronium 44 μg once-daily on lung volumes and exercise tolerance in 16 patients with severe COPD, of which 8 received roflumilast and 8 ciclesonide for 8 weeks. Detailed pulmonary function and endurance shuttle tests were performed at time 0, after 2 weeks of glycopyrronium and after 8 weeks of add-on of either roflumilast or ciclesonide. Glycopyrronium increased significantly (p < .05) FEV

Topics: Administration, Inhalation; Administration, Oral; Aged; Albuterol; Aminopyridines; Benzamides; Cyclopropanes; Drug Therapy, Combination; Exercise Tolerance; Female; Glucocorticoids; Glycopyrrolate; Humans; Lung Volume Measurements; Male; Middle Aged; Muscarinic Antagonists; Phosphodiesterase 4 Inhibitors; Pilot Projects; Pregnenediones; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Severity of Illness Index

Topics: Administration, Inhalation; Asthma; COVID-19; Humans; Pregnenediones; Pulmonary Disease, Chronic Obstructive

Topics: Administration, Inhalation; Asthma; COVID-19; Humans; Pregnenediones; Pulmonary Disease, Chronic Obstructive

Topics: Administration, Inhalation; Adrenergic beta-2 Receptor Agonists; Albuterol; Asthma; Ethanolamines; Forecasting; Formoterol Fumarate; Glucocorticoids; Humans; Mometasone Furoate; Muscarinic Antagonists; Pregnadienediols; Pregnenediones; Pulmonary Disease, Chronic Obstructive; Salmeterol Xinafoate; Scopolamine Derivatives; Tiotropium Bromide

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adrenergic beta-2 Receptor Agonists; Anti-Inflammatory Agents; Asthma; Bronchodilator Agents; Drug Therapy, Combination; Ethanolamines; Evidence-Based Medicine; Formoterol Fumarate; Humans; Muscarinic Antagonists; Nebulizers and Vaporizers; Pregnenediones; Pulmonary Disease, Chronic Obstructive; Scopolamine Derivatives; Tiotropium Bromide; Treatment Outcome