ABSTRACT
No published data from this past year provide new insight on the safety and tolerability of corticosteroids, β2-adrenoreceptor agonists, or phosphodiesterase inhibitors as they pertain to respiratory diseases. While systemic corticosteroids have become a valuable therapeutic agent in treating Covid-19 pneumonia, there have been no new or unexpected adverse events reported within this context. For the leukotriene modifying agents (LTMA), the safety of leukotriene receptor antagonists (LTRA) in pediatric patients was evaluated in a systematic review, providing confirmation of known psychiatric and gastrointestinal adverse events for this drug class. In addition, a retrospective study reported that parasthesia in the extremeties developed during montelukast use in pediatric patients. This adverse event has not been previously reported. For inhaled anticholinergic drugs, published reports have recently described the safety of umeclidinium, revafenacin, and glycopyrolate in Asian patients. In addition, new insight into the association between ipratropium and mydriasis has been described in a few case reports as well as a cohort study. For the antifibrotic drugs nintedanib and pirfenidone, new reports describe the safety of these drugs for new indications, including Covid-19 pneumonia. There are also case reports describing unique side effects of these drugs, including anti-cancer effects. Lastly, there are new reports describing the safety of a new monoclonal antibody therapy for severe asthma (tezepelumab), the safety of omalizumab in specific subpopulations, as well as a few reports describing the combination of mepolizumab and omalizumab for refractory severe asthma.
ABSTRACT
INTRODUCTION: Discordance between real-world prescribing patterns and global treatment guidelines for the treatment of chronic obstructive pulmonary disease (COPD) with inhaled single or dual long-acting bronchodilator maintenance therapy is increasingly being reported in the literature, particularly with regard to addition of inhaled corticosteroids (ICS). Patient-related factors, e.g. inhalation technique and inspiratory flow, are key to disease control in COPD. Treatment discordance and patient-related factors can lead to high-cost side effects and sub-optimal treatment benefit; furthermore, the COVID-19 pandemic has led to new challenges in COPD management. AREAS COVERED: This article summarizes a series of presentations sponsored by Boehringer Ingelheim and delivered at the annual CHEST congress 2021 (October 17-20, 2021) that explored new insights into the optimal management of COPD. EXPERT OPINION/COMMENTARY: There is a concerning high degree of discordance with GOLD recommendations. Dual therapy without addition of ICS does not increase exacerbation risk and could reduce pneumonia risk, and unnecessary prescription of triple therapy has financial implications. Clinic-based spirometry may not reflect the home setting, and training is required; inhalers that operate independently of users' inhalation profiles should be considered. Integration of digital healthcare solutions into clinical studies is suggested in the post-COVID setting, although further evaluation is required.