Indacaterol is an ultra-long-acting β-2 adrenergic agonist which can be administered once daily for the treatment of Chronic Obstructive Pulmonary Disease (COPD). In Australia, indacaterol has recently been listed for subsidized supply under the auspices of the Pharmaceutical Benefits Schedule (for this indication only).
The pharmacological effects of β-2 adrenoreceptor agonists can be partly credited to the intracellular stimulation of adenyl cyclase. This enzyme catalyzes the conversion of adenosine tri phosphate (ATP) to cyclic 3’,5 adenosine monophosphate. These raised cyclic AMP levels cause relaxation of bronchial smooth muscle. In vitro studies have shown that indacaterol has more than a 24-fold greater agonist activity at β-2 receptors compared to β-1 receptors, and a 20-fold greater agonist activity compared to β-3 receptors. This degree of selectivity is similar to that observed with eformoterol.
Read the complete bulletin:
Download (PDF, 24.26KB)
Tagged as:
chronic obstructive airways disease,
COPD,
Indacaterol,
RGH E-bulletin
Inhaled corticosteroids (ICS) are first-line therapy for asthma and are also commonly used in the treatment of chronic obstructive pulmonary disease (COPD), in particular for those patients with moderate–severe disease and frequent exacerbations. They are preferred to oral corticosteroids because of a lower risk of systemic adverse effects, although high doses of ICS have been reported to be associated with adrenal suppression, glaucoma, osteoporosis, cataracts, pneumonia, bruising and decreased growth in children.
Oral corticosteroids increase the risk of diabetes mellitus and worsen glucose control in patients already diagnosed with the disease. Case reports have linked high doses of ICS with loss of glucose control, but a randomised controlled trial in patients with mild-moderate COPD (n= 1116) did not find an increased risk of diabetes associated with ICS use. The small number of subjects in this trial is a major limitation.
Download the PDF below to continue reading.
Download (PDF, 12.55KB)
The 2009 RGH E-Bulletins are archived here.
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
asthma,
COPD,
corticosteroids,
diabetes,
RGH E-bulletin
β-blockers have been shown to have several beneficial effects in cardiovascular disease and therefore are used for a variety of indications such as post-myocardial infarction, congestive heart failure, hypertension, angina and arrhythmias.
Despite these benefits, β-blockers are often under-prescribed in COPD patients due to belief that they can precipitate respiratory deterioration or cause bronchospasm. This E-bulletin aims to summarise some of the existing evidence on using β-blockers in COPD patients.
A Cochrane Review conducted in 2008 included 20 randomised control trials showed that cardio-selective β-blockers produced no change in FEV1 or respiratory symptoms compared to placebo, even in patients with severe COPD or for those with a reversible obstructive component. This review concluded that cardio-selective β-blockers should not be routinely withheld from patients with COPD. It should however be noted that the studies included in this review were generally small and of short duration (11 involved single doses), some were single blinded only and some did not include a placebo group.
Download (PDF, 26.93KB)
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
Beta blockers,
congestive heart failure,
COPD,
RGH E-bulletin
Patients affected by Chronic Obstructive Pulmonary Disease (COPD) experience chronic symptoms and exacerbations with reduced quality of life despite treatment. Current treatment options for COPD include inhaled short-acting and longacting bronchodilators (either β2-agonists and/or anticholinergic drugs).
Inhaled corticosteroids are added to reduce frequent exacerbations but, among other side effects, there is concern about increased pneumonia risk when inhaled corticosteroids are used in COPD.
Phosphodiesterases (PDE) are the superfamily of enzymes that inactivate the intracellular second messengers cAMP and cGAMP. The known enzymes in the family have different tissue distribution and substrate specificity, and hence are targets for drug design and research. A range of specific PDE isoenzymes have been studied in a range of diseases, notably, erectile dysfunction.
Download (PDF, 18.88KB)
The 2009 RGH E-Bulletins are archived here.
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
COPD,
Phosphodiesterase,
Phosphodiesterase 4 inhibitors,
RGH E-bulletin
