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| Pulmonary Drugs |
The lungs are an essential organ that allow us to breathe and exchange gases. However, several medical conditions can affect the normal functioning of lungs. Pulmonary drugs help to treat and manage diseases related to lungs such as asthma, bronchitis, pneumonia etc. In this article, we will discuss some of the major classes of pulmonary drugs used to treat respiratory disorders.
Bronchodilators
Bronchodilators are one of the most commonly prescribed classes of pulmonary drugs. These drugs help open up or dilate the airways by relaxing the muscles around bronchioles. There are two main types of bronchodilators- short-acting and long-acting.
Short-acting bronchodilators
Short-acting bronchodilators like albuterol and levalbuterol provide fast relief from bronchospasm and work within 5-15 minutes. Pulmonary Drugs are usually prescribed through inhalers to be used as needed for quick relief from symptoms like wheezing, coughing and chest tightness. Although effective for acute attacks, their effects last for only 3-6 hours.
Long-acting bronchodilators
Due to their shorter duration of action, short-acting bronchodilators are not ideal for maintaining airflow throughout the day. This is where long-acting bronchodilators play a role. Drugs like salmeterol, formoterol and arformoterol maintain bronchodilation for 12 hours or more through slow release formulations. They are prescribed for regular daily use to control symptoms and prevent exacerbations.
Corticosteroids
Corticosteroids are highly effective anti-inflammatory drugs used to reduce inflammation in airways. Inhaled corticosteroids (ICS) are first-line therapy for persistent asthma as they can effectively prevent symptoms, exacerbations and reduce the need for rescue medications. Common ICS drugs include beclometasone, budesonide, fluticasone etc. Oral corticosteroids like prednisone are sometimes prescribed during acute asthma exacerbations to gain better control.
Leukotriene modifiers
Leukotrienes are inflammatory mediators that play a role in asthma. Leukotriene modifiers inhibit the actions of leukotrienes and hence, help improve asthma control. Drugs like montelukast, zafirlukast and zileuton are used as add-on therapy along with ICS for patients with persistent asthma. They help reduce systemic corticosteroid use and are especially useful for those with aspirin sensitivity.
MAbs and Biologics
For severe persistent asthma not controlled by above drugs, monoclonal antibodies (MAbs) and biologics targeting specific inflammatory pathways are used. Omalizumab is a monoclonal antibody that targets immunoglobulin E (IgE) while mepolizumab, reslizumab and benralizumab target specific inflammatory cells like eosinophils. These biologics significantly reduce exacerbation rates and improve symptom control in severe eosinophilic asthma.
Combination Drugs
Combination inhalers containing both a bronchodilator and corticosteroid are highly advantageous as they allow delivery of two drugs with a single inhalation. Common examples include fluticasone propionate and salmeterol, budesonide and formoterol. These fixed dose combinations simplify treatment regimen, promote adherence and provide better disease control compared to separate delivery of individual drugs.
Anti-infective Drugs
Anti-infective drugs play a critical role in treating pulmonary infections like pneumonia, bronchitis etc. Common classes include antibiotics (aminoglycosides, macrolides, fluoroquinolones), antivirals and antifungals. Drugs choice depends on the causative organism and its susceptibility pattern. For example, amoxicillin is first-line for community-acquired pneumonia while doxycycline is preferred in situations with atypical pathogen coverage. Antiviral drugs are used to treat respiratory viral infections like influenza.
Other Drugs
Other drugs approved or being researched for respiratory disorders include mucolytics to thin out thick mucus, bromhexine, cystic fibrosis drugs like ivacaftor for certain mutations, drugs facilitating clearing of mucus like DNAse. Agents inhibiting fibrotic changes like nintedanib are under investigation for pulmonary fibrosis treatment and management. Further, several herbal and Ayurvedic formulations are also used as supportive or adjunct therapy.
Tremendous progress has been made in managing chronic respiratory diseases with the development of various classes of effective and safe pulmonary drugs. However, more research focused on developing safer new generation biologics, targeted therapies, is warranted to improve quality of life in patients suffering from lung disorders. With continual advances, more lives stand to benefit from better treatment options in the future.
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