Indacaterol (arcapta neohaler) for chronic obstructive pulmonary disease.
Year: 2012
Type: article
Abstract: Chronic obstructive pulmonary disease (COPD) is the collective term for a lower respiratory tract condition that includes chronic bronchitis and emphysema.1,2 It is a partially reversible condition characterized by chronic, progressive difficulty with expiration of air from the lungs. COPD causes patients great distress and can have significant negative effects on their quality of life.1
Mortality from COPD continues to increase.2–4 According to data from the 2008 National Center for Health Statistics, COPD has replaced stroke as the third leading cause of death in the U.S.3 It is estimated that 11.8 million people (7.4 million women, 4.4 million men) over 18 years of age are affected.3 The highest prevalence of COPD occurs in adults who have a family income below the federal poverty level and who are of Puerto Rican (6.9%) or non-Hispanic Caucasian (5.7%) descent.2 The change of COPD from the fourth leading cause of death to the third makes it the only deadly health condition whose incidence has increased over the past 30 years.2–4 Recent data also suggest that COPD is the 12th leading cause of morbidity in the U.S.5
COPD can be differentiated from asthma, another chronic lower respiratory tract condition, by its onset, frequency, and cause of symptoms, and its long-term responsiveness to treatment.1,4 Generally, COPD is diagnosed in patients 40 years of age or older who smoke or formerly smoked cigarettes, whereas asthma is diagnosed in early childhood or adolescence. Symptoms of COPD are ongoing and are commonly exacerbated by respiratory infection; however, some patients with asthma may be relatively symptom-free until they are exposed to certain irritants (e.g., cold air, allergens, and exercise) that prompt an attack.1,4
Unlike asthma, the airflow limitation present in COPD is not fully reversible; however, the symptoms (cough, wheezing, breathlessness, and mucus production) can be improved and controlled with medications.1,4 It is possible for a patient to have both COPD and asthma.1,2 There is no cure for COPD.1,2,4
The diagnosis and management of COPD are described in two guidelines: the Global Initiative for Obstructive Lung Disease (GOLD) criteria and the American College of Physicians (ACP) Clinical Practice guidelines.5,6 These publications recommend a progressive addition of medication based on the stage of COPD (I = mild, II = moderate, III = severe, and IV = very severe), with the goals of improving symptoms (dyspnea, poor exercise tolerance, and cough) and of reducing the frequency and severity of exacerbations.1,5
The stage of COPD is determined by spirometry, including forced expiratory volume in 1 second (FEV1) and the ratio of FEV1 to forced vital capacity (FVC), or FEV1:FVC. In general, dyspnea is controlled with short-acting bronchodilators (beta agonists), as needed, in stage I COPD (FEV1 ≥ 80% and FEV1:FVC < 70%), followed by the addition of long-acting bronchodilators (beta agonists or anticholinergics), which are used on a regular basis in stage II COPD (FEV1 50%–80% and FEV1:FVC < 70%). Inhaled glucocorticoids are initiated in stage III COPD (FEV1 30%–50% and FEV1:FVC < 70%) when patients experience repeated exacerbations. Long-term oxygen therapy is initiated in stage IV COPD (FEV1 ≤ 30% and FEV1:FVC < 70%).5
Three long-acting beta-agonists (LABAs) are currently on the market in the U.S. Salmeterol (Serevent, Glaxo-SmithKline) is available in a dry-powder inhaler and is administered twice daily.7 The once-daily formulations include formoterol, available in a dry-powder inhaler (Foradil, Schering) and as a solution for nebulization (Perforomist, Dey). Arformoterol (Brovana, Sunovion) is available only as a solution for nebulization. LABAs are used as single-ingredient or combination therapies. In addition to these agents, a long-acting, once-daily anticholinergic preparation, tiotropium (Spiriva, Pfizer) is available in a dry-powder inhaler.1,7
On July 1, 2011, the FDA approved a new molecular entity, indacaterol maleate (Arcapta Neohaler, Novartis), for the treatment of airflow obstruction in patients with COPD.9 It is categorized as a LABA, and only once-daily administration is required.8 Tables 1 and and22 present a comparison of indacaterol with other available LABAs.
Table 1
Currently Available Long-Acting Beta-Agonist (LABA) Preparations
Source: Europe PMC (PubMed Central)
Authors: Rachel M Slaton, Danielle L Cruthirds
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W157990254