Handbook of Experimental Pharmacology 237 Clive P. Page Peter J. Barnes Editors Pharmacology and Therapeutics of Asthma and COPD Handbook of Experimental Pharmacology Volume 237 Editor-in-Chief J.E.Barrett,Philadelphia EditorialBoard V.Flockerzi,Homburg M.A.Frohman,StonyBrook,NY P.Geppetti,Florence F.B.Hofmann,Mu¨nchen M.C.Michel,Mainz C.P.Page,London W.Rosenthal,Berlin K.Wang,Beijing More information about this series at http://www.springer.com/series/164 Clive P. Page (cid:129) Peter J. Barnes Editors Pharmacology and Therapeutics of Asthma and COPD Editors CliveP.Page PeterJ.Barnes SacklerInstituteofPulmonary AirwayDiseaseSection,ImperialCollege Pharmacology,Instituteof NationalHeartandLungInstitute PharmaceuticalScience London,UnitedKingdom King’sCollegeLondon London,UnitedKingdom ISSN0171-2004 ISSN1865-0325 (electronic) HandbookofExperimentalPharmacology ISBN978-3-319-52173-2 ISBN978-3-319-52175-6 (eBook) DOI10.1007/978-3-319-52175-6 LibraryofCongressControlNumber:2016963071 #SpringerInternationalPublishingAG2017 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilarmethodologynowknownorhereafterdeveloped. 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Printedonacid-freepaper ThisSpringerimprintispublishedbySpringerNature TheregisteredcompanyisSpringerInternationalPublishingAG Theregisteredcompanyaddressis:Gewerbestrasse11,6330Cham,Switzerland We have dedicated this volume to Dr Dom SpinawhosadlypassedawayonDecember5, 2016.DrSpinahadmademajorcontributions to the field of Pulmonary Pharmacology throughouthiscareer, notleastinthe areaof xanthines and phosphodiesterase inhibitors, the subject of his contribution to this volume. Hewillbesorelymissed byallwhoknew and had the privilege of working with him. Preface In2004weeditedVolume161onthePharmacologyandTherapeuticsofAsthma and COPD aspart ofthisprestigious series. Over the last decadethere have been substantial increases in our understanding of the mechanisms underlying asthma andCOPD,aswellasinthetreatmentoftheseimportantdiseases.Wehavebrought together internationally recognized authorities to review the most important new informationontheadvancesinourunderstandingofthepathogenesisandtreatment of these diseases, including the substantial advances in the topical delivery of inhaled medicines. It is hoped that this book will be invaluable for research scientistsandcliniciansinvolvedinresearchintoasthmaandCOPD,andthatthis volumewillbeamajorreferenceresourceforchestphysiciansandthoseinvolved inthedevelopmentofnovelpharmaceuticalentitiesforthesediseases. Each chapter is extensively referenced, generously illustrated with clear diagramsandphotographs,andrepresentsastate-of-the-artreviewofthisimportant areaofrespiratorymedicine. London,UK C.P.Page December2016 P.J.Barnes vii Contents PathogenesisofCOPDandAsthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ClivePage,BlazeO’Shaughnessy,andPeterBarnes β Agonists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 2 CharlotteK.Billington,RaymondB.Penn,andIanP.Hall MuscarinicReceptorAntagonists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 MariaGabriellaMateraandMarioCazzola XanthinesandPhosphodiesteraseInhibitors. . . . . . . . . . . . . . . . . . . . . 63 D.SpinaandC.P.Page Glucocorticosteroids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 PeterJ.Barnes Fixed-DoseCombinationInhalers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 MarioCazzolaandMariaGabriellaMatera Anti-IgEandBiologicApproachesfortheTreatmentofAsthma. . . . . 131 PatrickD.Mitchell,AmaniI.El-Gammal,andPaulM.O’Byrne LeukotrieneReceptorAntagonistsandAntiallergyDrugs. . . . . . . . . . . 153 TsutomuTamadaandMasakazuIchinose Glucocorticoids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 IanM.AdcockandSharonMumby BifunctionalDrugsfortheTreatmentofRespiratoryDiseases. . . . . . . 197 ClivePageandMarioCazzola DrugsAffectingTRPChannels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 M.A.Wortley,M.A.Birrell,andM.G.Belvisi EvaluationofNewDrugsforAsthmaandCOPD:Endpoints, BiomarkersandClinicalTrialDesign. . . . . . . . . . . . . . . . . . . . . . . . . . 243 DaveSingh ix x Contents DrugDeliveryDevicesforInhaledMedicines. . . . . . . . . . . . . . . . . . . . 265 AnneLexmondandBenForbes Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 Pathogenesis of COPD and Asthma Clive Page, Blaze O’Shaughnessy, and Peter Barnes Contents 1 PathologyofCOPD......................................................................... 2 2 ChronicInflammation....................................................................... 3 3 AcceleratedAgeing......................................................................... 5 4 OxidativeStress............................................................................. 6 5 Pathophysiology............................................................................. 7 6 CausesandPathogenesisofExacerbations................................................ 8 7 PathologyofAsthma........................................................................ 9 8 AirwaysInflammation...................................................................... 10 9 BronchialHyper-Responsiveness........................................................... 13 10 AirwayRemodellinginAsthma............................................................ 15 11 SevereAsthmaandFrequentExacerbations............................................... 17 References........................................................................................ 18 Abstract Asthma and COPD remain two diseases of the respiratory tract with unmet medical needs. This review considers the current state of play with respect to what is known about the underlying pathogenesis of these two chronic inflam- matory diseases of the lung. The review highlights why they are different conditionsrequiringdifferentapproachestotreatmentandprovidesabackdrop for the subsequent chapters in this volume discussing recent advances in the pharmacologyandtreatmentofasthmaandCOPD. C.Page(*)•B.O’Shaughnessy SacklerInstituteofPulmonaryPharmacology,King’sCollegeLondon,150StamfordStreet, LondonSE19NH,UK e-mail:[email protected] P.Barnes DepartmentofThoracicMedicine,NationalHeartandLungInstitute,ImperialCollegeLondon, DovehouseStreet,LondonSW36LY,UK #SpringerInternationalPublishingAG2016 1 C.P.Page,P.J.Barnes(eds.),PharmacologyandTherapeuticsofAsthmaand COPD,HandbookofExperimentalPharmacology237,DOI10.1007/164_2016_61