Pathophysiology, Therapeutic Targets, and Future Therapeutic Alternatives in COPD: Focus on the Importance of the Cholinergic System
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airway limitation and changes in airway structure. It has a high global burden of mortality and morbidity. The etiology of COPD is complex, but exposure to tobacco smoke and other inhaled lung oxidants are major r...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-03-01
|
| Series: | Biomolecules |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2218-273X/13/3/476 |
| _version_ | 1797613205337407488 |
|---|---|
| author | Felisbela Gomes Shih-Lung Cheng |
| author_facet | Felisbela Gomes Shih-Lung Cheng |
| author_sort | Felisbela Gomes |
| collection | DOAJ |
| description | Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airway limitation and changes in airway structure. It has a high global burden of mortality and morbidity. The etiology of COPD is complex, but exposure to tobacco smoke and other inhaled lung oxidants are major risk factors. Both pharmacological and non-pharmacological approaches are used to manage COPD, but there remains an urgent unmet need for drugs that can modify the course of the disease. This review focuses on the role of acetylcholine and other components of the pulmonary cholinergic system in the pathogenesis of COPD, and the inhaled pharmacological agents that target it. In addition to its role as a neurotransmitter, acetylcholine regulates diverse aspects of COPD pathogenesis including bronchoconstriction, airway remodeling, mucus secretion and inflammation. Inhaled antimuscarinic drugs are a key component of therapy for COPD, as monotherapy or in combination with inhaled β2 agonists or corticosteroids. We review the evidence supporting the use of current anticholinergic agents in COPD and preview novel drugs targeting the cholinergic system and agents from other classes in clinical development, such as phosphodiesterase-4 inhibitors and monoclonal antibodies targeting inflammatory mediators. |
| first_indexed | 2024-03-11T06:52:33Z |
| format | Article |
| id | doaj.art-6c6f9dccfd934801ad3a4bcb9ae9e129 |
| institution | Directory Open Access Journal |
| issn | 2218-273X |
| language | English |
| last_indexed | 2024-03-11T06:52:33Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomolecules |
| spelling | doaj.art-6c6f9dccfd934801ad3a4bcb9ae9e1292023-11-17T09:51:50ZengMDPI AGBiomolecules2218-273X2023-03-0113347610.3390/biom13030476Pathophysiology, Therapeutic Targets, and Future Therapeutic Alternatives in COPD: Focus on the Importance of the Cholinergic SystemFelisbela Gomes0Shih-Lung Cheng1Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22000, TaiwanDepartment of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22000, TaiwanChronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airway limitation and changes in airway structure. It has a high global burden of mortality and morbidity. The etiology of COPD is complex, but exposure to tobacco smoke and other inhaled lung oxidants are major risk factors. Both pharmacological and non-pharmacological approaches are used to manage COPD, but there remains an urgent unmet need for drugs that can modify the course of the disease. This review focuses on the role of acetylcholine and other components of the pulmonary cholinergic system in the pathogenesis of COPD, and the inhaled pharmacological agents that target it. In addition to its role as a neurotransmitter, acetylcholine regulates diverse aspects of COPD pathogenesis including bronchoconstriction, airway remodeling, mucus secretion and inflammation. Inhaled antimuscarinic drugs are a key component of therapy for COPD, as monotherapy or in combination with inhaled β2 agonists or corticosteroids. We review the evidence supporting the use of current anticholinergic agents in COPD and preview novel drugs targeting the cholinergic system and agents from other classes in clinical development, such as phosphodiesterase-4 inhibitors and monoclonal antibodies targeting inflammatory mediators.https://www.mdpi.com/2218-273X/13/3/476chronic obstructive pulmonary diseaseinflammationacetylcholinemuscarinic antagonistsβ2 agonistsPDE4 inhibitors |
| spellingShingle | Felisbela Gomes Shih-Lung Cheng Pathophysiology, Therapeutic Targets, and Future Therapeutic Alternatives in COPD: Focus on the Importance of the Cholinergic System Biomolecules chronic obstructive pulmonary disease inflammation acetylcholine muscarinic antagonists β2 agonists PDE4 inhibitors |
| title | Pathophysiology, Therapeutic Targets, and Future Therapeutic Alternatives in COPD: Focus on the Importance of the Cholinergic System |
| title_full | Pathophysiology, Therapeutic Targets, and Future Therapeutic Alternatives in COPD: Focus on the Importance of the Cholinergic System |
| title_fullStr | Pathophysiology, Therapeutic Targets, and Future Therapeutic Alternatives in COPD: Focus on the Importance of the Cholinergic System |
| title_full_unstemmed | Pathophysiology, Therapeutic Targets, and Future Therapeutic Alternatives in COPD: Focus on the Importance of the Cholinergic System |
| title_short | Pathophysiology, Therapeutic Targets, and Future Therapeutic Alternatives in COPD: Focus on the Importance of the Cholinergic System |
| title_sort | pathophysiology therapeutic targets and future therapeutic alternatives in copd focus on the importance of the cholinergic system |
| topic | chronic obstructive pulmonary disease inflammation acetylcholine muscarinic antagonists β2 agonists PDE4 inhibitors |
| url | https://www.mdpi.com/2218-273X/13/3/476 |
| work_keys_str_mv | AT felisbelagomes pathophysiologytherapeutictargetsandfuturetherapeuticalternativesincopdfocusontheimportanceofthecholinergicsystem AT shihlungcheng pathophysiologytherapeutictargetsandfuturetherapeuticalternativesincopdfocusontheimportanceofthecholinergicsystem |