Therapeutic approaches to asthma-chronic obstructive pulmonary disease overlap syndromes.
The recognition that there are some patients with features of asthma and chronic obstructive pulmonary disease (COPD) has highlighted the need to develop more specific treatments for these clinical phenotypes. Some patients with COPD have predominantly eosinophilic inflammation and might respond to high doses of inhaled corticosteroids and newly developed specific antieosinophil therapies, including blocking antibodies against IL-5, IL-13, IL-33, and thymic stromal lymphopoietin, as well as oral chemoattractant receptor-homologous molecule expressed on TH2 cells antagonists. Other patients have severe asthma or are asthmatic patients who smoke with features of COPD-induced inflammation and might benefit from treatments targeting neutrophils, including macrolides, CXCR2 antagonists, phosphodiesterase 4 inhibitors, p38 mitogen-activating protein kinase inhibitors, and antibodies against IL-1 and IL-17. Other patients appear to have largely fixed obstruction with little inflammation and might respond to long-acting bronchodilators, including long-acting muscarinic antagonists, to reduce hyperinflation. Highly selected patients with severe asthma might benefit from bronchial thermoplasty. Some patients with overlap syndromes can be conveniently treated with triple fixed-dose combination inhaler therapy with an inhaled corticosteroid, long-acting β2-agonist, and long-acting muscarinic antagonist, several of which are now in development. Corticosteroid resistance is a feature of asthma-COPD overlap syndrome, and understanding the various molecular mechanisms of this resistance has identified novel therapeutic targets and presented the prospect of therapies that can restore corticosteroid responsiveness.
National Heart and Lung Institute, Imperial College, London, United Kingdom. Electronic address: p.j.barnes@imperial.ac.uk.
Peter J
PJ
Barnes
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D057134:Antibodies, Neutralizing / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016207:Cytokines / Q000037:antagonists & inhibitors* / Q000096:biosynthesis; D004804:Eosinophils / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D010641:Phenotype; D058988:Phosphodiesterase 4 Inhibitors / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D057134:Antibodies, Neutralizing; D001993:Bronchodilator Agents; D016207:Cytokines; D018942:Macrolides; D018727:Muscarinic Antagonists; D058988:Phosphodiesterase 4 Inhibitors; D047428:Protein Kinase Inhibitors
Corticosteroids; IgE; bronchial thermoplasty; bronchodilator; chemokine; corticosteroid resistance; cytokine; kinase; macrolide; p38 mitogen-activated protein kinase