Lung Biology in Health Disease Volume 182 Pharmacotherapy in Chronic Obstructive Pulmonary Disease 1st Edition by Bartolome Celli ISBN 978-0824740290 0824740290

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ISBN 10:  0824740290

ISBN 13: 978-0824740290

Author: Bartolome R. Celli 

Placing specialists at the cutting-edge of therapeutic and biotechnological research, this reference reviews the extensive array of pharmaceutical options available for the management of patients with COPD. The book considers disease severity, dosing regimens, administration methods, and monitoring procedures, as well as medication-related side-effects for improved lung function, reduction of disease symptoms, and enhanced quality of life. Contributions from world-renowned authorities reflect recent practices, controversies, and procedures in the control of COPD symptoms and detail the development and efficacy of therapies such as anticholinergics, beta adrenergics, and corticosteroids.

Table of contents: 

Part One THE APPLICATION OF CLINICAL

ASSESSMENT TO THE DRUG DEVELOPMENT PROCESS

1. Providing Evidence of Therapeutic Benefit in Clinical Drug Development

Steven Kesten and Theodore J. Witek

I. Introduction

II. Regulation in the Development of Drugs

III. Key Considerations in Clinical Program Designs

IV. Key Considerations in Endpoints: Application to COPD

V. Summary

References

Part Two MEASURING OUTCOMES

A. Physiology

2. Use of Expiratory Airflows and Lung Volumes to Assess Outcomes in COPD

Gary T. Ferguson

I. Introduction

II. Expiratory Airflows

III. Lung Volumes

IV. Other Measures

V. Bronchodilator Reversibility and Airway Hyperreactivity

VI. Clinical Relevance

VII. Conclusion and Recommendations References

3. Exercise Testing

Denis E. O’Donnell and Katherine A. Webb

I. Introduction

II. Exercise Limitation in COPD

III. Exercise Testing: Field Tests

IV. Exercise Testing: Laboratory Tests

V. Failure to Improve Exercise Performance After Bronchodilators

VI. Evaluating Mechanisms of Functional Improvement

VII. Utility of Constant-Load Exercise Testing: Examples

VIII. Summary References

4. Sleep-Related Breathing Disturbances in COPD

Walter T. McNicholas

I. Introduction

II. Effects of Sleep on Respiration

III. Sleep in Chronic Obstructive Pulmonary Disease

IV. Mechanisms of Nocturnal Oxygen Desaturation in COPD

V. Consequences of Nocturnal Hypoxaemia in COPD

VI. Sleep Quality in COPD

VII. Contrasts with Exercise

VIII. Investigation of Sleep-Related Breathing Disturbances in COPD

IX. Management of Respiratory Abnormalities During Sleep in COPD

X. Pharmacological Therapy

XI. Conclusion

References

5. Airway and Alveolar Determinants of Airflow Limitation in COPD

Something Zamel

I. Introduction

II. Large-Airways Airflow Limitation

III. Small-Airways Airflow Limitation

IV. Alveolar Airflow Limitation References

6. Gas Exchange

Antoni Ferrer, Joan Albert Barberà, and Roberto Rodriguez-Roisin

I. Introduction

II. Bronchodilators

III. Glucocorticosteroids

IV. Vasodilators

V. Other Drugs

References

B. Laboratory

7. Genetics of COPD

Jian-Qing He, Ikuma Kasuga, and Peter D. Pare

I. Introduction

II. Evidence of Genetic Risk

III. Methods to Identify Susceptibility Genes

IV. Phenotypes

V. Candidate Genes in COPD

VI. Therapeutic Implications of COPD Genetics

VII. Pharmacogenetics of COPD

VIII. Conclusion

References

C. Health Outcomes

8. Dyspnea

Donald A. Mahler

I. Introduction

II. The Measurement of Dyspnea

III. Responsiveness

IV. Summary References

9. Exacerbations of COPD

Jadwiga A. Wedzicha

I. Definition of a COPD Exacerbation

II. Exacerbation Frequency

III. Goals of Exacerbation Therapy

IV. Therapy of the Acute Exacerbation

V. Prevention of COPD Exacerbation

VI. Conclusion References

10. Health Status Measurement in COPD

Paul W. Jones

I. Introduction: The Multifactorial Nature of COPD

II. Measuring the Overall Effect of Treatment

III. Health Status Questionnaires

IV. Thresholds for Clinical Significance

V. Health Status Changes Following Treatment

VI. Longitudianl Trends in Health Status

VII. Implications for Practice

VIII. Assessment of Individual Patient Benefit

IX. Summary

References

11. Health Resource Utilization

Mitchell Friedman

I. COPD-The Challenge

II. Helath Care Utilization in COPD

III. Economic Burden of COPD References

Part Three SPECIFIC THERAPY

12. Anticholinergics

Peter J. Barnes

I. Introduction

II. Rationale for Anticholinergic Therapy in COPD

III. Muscarinic Receptor Subtypes in the Airways

IV. The Search for Selective Anticholinergics

V. Tiotropium Bromide

VI. Pharmacokinetics

VII. Side Effects

VIII. Future Prospects

References

13. B-Adrenergic Receptor Agonist Bronchodilators in the Treatment of COPD

Stephen I. Rennard

I. Introduction

II. Mechanism of Action

III. Clinical Response

IV. Adverse Effects of B-Agonists

V. Clinical Assessment of the COPD patient

VI. Effect of Dyspnea

VII. Effect on Exercise

VIII. Quality of Life

IX. Exacerbations

X. Use of B-Agonist Bronchodilators in Clinical Practice

XI. Summary References

14. Theophylline and Phosphodiesterase Inhibitors in COPD

Alicia R. ZuWallack and Richard L. ZuWallack

I. Introduction

II. Molecular Mechanisms of Action of Theophylline and Other PDE Inhibitors

III. Pharmacological Effects of Theophylline

IV. Pharmacokinetics

V. Dosing and Monitoring of Theophylline

VI. Toxicity

VII. The Effectiveness of Theophylline on Important Outcomes for COPD

VIII. Selective Phosphodiesterase Inhibitors in the Treatment of COPD

IX. The Role of Theophylline in the Acute Exacerbation of COPD

X. Theophylline and Phosphodiesterase Inhibitors Use in COPD: Where Does It Fit In?

References

15. Corticosteroids in COPD

Mario Cazzola, Maria Gabriella Matera, and Romain Pauwels

I. Introduction

II. Impact of Corticosteroids on Inflammation in COPD

III. Clinical Effects of Corticosteroids in COPD

IV. Adverse Effects

V. Corticosteroids and Guidelines

VI. Combining an Inhaled Corticosteroid and a Long-Acting B2-Agonist in COPD

VII. Conclusion References

16. Antioxidants and Protease Inhibitors

Mario Cazzola and Maria Gabriella Matera

I. Introduction

II. Oxidative Stress and COPD

III. Proteases and COPD

IV. Conclusions References

17. An Integrated Approach to the Pharmacological Therapy of COPD

Bartolome R. Celli

I. Introduction

II. Change in Paradigm: A Constructive Analogy with Systemic Hypertension

III. Proof of Concept

IV. COPD: A Pulmonary Disease with Systemic Consequences

V. General Principles of Pharmacological Therapy in COPD

VI. Initiation of Drug Therapy

VII. Use of Corticosteroids

VIII. Other Medications

IX. Management of Acute Exacerbations

X. Summary and Conclusion References

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