Santus Pierachille, Radovanovic Dejan, Cristiano Andrea, Valenti Vincenzo, Rizzi Maurizio
Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
Department of Health Bioscience, University of Milan - Respiratory Unit, Policlinico di San Donato, IRCCS - San Donato Milanese, Milan, Italy.
Drug Des Devel Ther. 2017 Nov 15;11:3257-3271. doi: 10.2147/DDDT.S135377. eCollection 2017.
In the upcoming years, the proportion of elderly patients with chronic obstructive pulmonary disease (COPD) will increase, according to the progressively aging population and the increased efficacy of the pharmacological treatments, especially considering the management of chronic comorbidities. The issue to prescribe an appropriate inhalation therapy to COPD patients with significant handling or coordination difficulties represents a common clinical experience; in the latter case, the choice of an inadequate inhalation device may jeopardize the adherence to the treatment and eventually lead to its ineffectiveness. Treatment options that do not require particular timing for coordination between activation and/or inhalation or require high flow thresholds to be activated should represent the best treatment option for these patients. Nebulized bronchodilators, usually used only in acute conditions such as COPD exacerbations, could fulfill this gap, enabling an adequate drug administration during tidal breathing and without the need for patients' cooperation. However, so far, only short-acting muscarinic antagonists have been available for nebulization. Recently, a nebulized formulation of the inhaled long-acting muscarinic antagonist glycopyrrolate, delivered by means of a novel proprietary vibrating mesh nebulizer closed system (SUN-101/eFlow), has progressed to Phase III trials and is currently in late-stage development as an option for maintenance treatment in COPD. The present critical review describes the current knowledge about the novel nebulizer technology, the efficacy, safety, and critical role of nebulized glycopyrrolate in patients with COPD. To this end, PubMed, ClinicalTrials.gov, Embase, and Cochrane Library have been searched for relevant papers. According to the available results, the efficacy and tolerability profile of nebulized glycopyrrolate may represent a valuable and dynamic treatment option for the chronic pharmacological management of patients with COPD.
随着人口的逐步老龄化以及药物治疗效果的提高，尤其是考虑到慢性合并症的管理，在未来几年中，老年慢性阻塞性肺疾病（COPD）患者的比例将会增加。对于有明显操作或协调困难的COPD患者，开具适当的吸入疗法是常见的临床经验；在后一种情况下，选择不合适的吸入装置可能会危及治疗依从性，并最终导致治疗无效。对于这些患者，不需要在激活和/或吸入之间进行特殊时间协调或需要高流量阈值才能激活的治疗选择应是最佳治疗方案。雾化支气管扩张剂通常仅用于COPD加重等急性情况，它可以填补这一空白，在潮式呼吸期间实现充分的药物给药，且无需患者配合。然而，到目前为止，仅有短效毒蕈碱拮抗剂可用于雾化。最近，一种通过新型专有振动网雾化器封闭系统（SUN-101/eFlow）递送的吸入长效毒蕈碱拮抗剂格隆溴铵雾化制剂已进入III期试验，目前正处于后期开发阶段，作为COPD维持治疗的一种选择。本综述描述了关于这种新型雾化器技术、雾化格隆溴铵在COPD患者中的疗效、安全性和关键作用的现有知识。为此，检索了PubMed、ClinicalTrials.gov、Embase和Cochrane图书馆中的相关论文。根据现有结果，雾化格隆溴铵的疗效和耐受性可能是COPD患者慢性药物管理的一种有价值且灵活的治疗选择。
