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SUPPLEMENT: Robert A. Stockley New Approaches to the Management of COPD Chest 2000; 117: 58S-62S [Abstract] [Full text] [PDF]

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Electronic letters published:

Managament of COPD

S K Agarwal   (23 February 2001)

Managament of COPD 23 February 2001
S K Agarwal, Head, Department of Chest Diseases, Institute of Medical Sciences, BHU, Varanasi, India Send letter to journal: Re: Managament of COPD sk_agarwal{at}satyam.net.in S K Agarwal	The author [1]has stressed on protease inhibitors and antioxidants as new approaches to the management of COPD. Several inflammatory mediators are implicated in COPD, providing logical targets for the development of synthesis inhibitors or receptor antagonists. These include 5-lipoxygenase inhibitors, which prevent the synthesis of leukotriene B4, and specific leukotriene B4 antagonists, several of which are now being evaluated for the treatment of COPD [2]. Specific antagonists of CXCR2, one of the receptors on neutrophils that are activated by interleukin-8, have been developed, and humanized antibodies and soluble receptors that block TNF- alpha have been developed. A better understanding of the cellular and molecular mechanisms involved in COPD provides new molecular targets for the development of drugs, and several classes of new drug are now in development[2]. Although corticosteroids are ineffective, other antiinflammatory treatments, particularly those that inhibit neutrophilic inflammation, might be effective. The most promising of these are phosphodiesterase 4 inhibitors, which have an inhibitory effect on key inflammatory cells involved in COPD. Current inhaler devices have been designated to deliver drugs optimally to the conducting airways in patients with asthma. However, COPD predominantly affects the peripheral airways and lung parenchyma, which may not be optimally targeted by current inhalers. It is likely that new inhaler device delivering smaller aerosolized particles will be more useful in COPD. In the future, targeted delivery to specific cells, such as macrophages, may be possible, References : 1. Stockley AR. New Approaches to the Management of COPD. Chest 2000;117 : 58S-62S 2.Barnes PJ. Medical Progress : COPD.The New Eng J of Med 2000;343:269