BETA 2 -AGONISTS IN ASTHMA TREATMENT

Transcription

1 BETA 2 -AGONISTS IN ASTHMA TREATMENT Edited by Romain Pauwels University Hospital Ghent, Belgium Paul M. O'Byrne McMaster University Hamilton, Ontario, Canada :MARCEL DEKKER, INC. NEW YORK BASEL HONG KONG

2 CONTENTS Claude Lenfant Hi Preface v Contributors vii 1. On the History of Sympathomimetics in Asthma 1 Carl G. A. Persson 1 I "Curative Influence of Violent Emotion" 2 II "Stress Therapies" of Asthma 2 Adrenal Extract 4 "Adrenal Substance" 5 V Adrenaline 7 VI Sympathomimetics and Mechanisms of Asthma 8 VII Life-Threatening Asthma 9 IX. Cocaine and Ephedrine 11 XI

3 ;ii X. "P-Agonists" for Asthma: Drugs Precede Theoretical Developments 12 X Molecular Biology of the Beta 2 -Adrenergic Receptor Focus on Interactions of Agonist with Receptor 19 Stephen B. Liggett and Stuart A. Green 19 I Features of G-Protein-Coupled Receptors 19 II Structure/Function Relationships of P2AR 21 Delineating a Specific Salmeterol Exosite Binding Motif in the p 2 AR Effect of Beta-Agonists on Airway Effector Cells 35 Peter J. Barnes 35 I Airway Smooth Muscle. 36 II Airway Nerves 39 Secretory Cells 40 Blood Vessels 42 V Inflammatory Cells 42 VI Regulation of Airway P-Receptors 45 VII Receptor Cross-Talk Bertil Waldeck Effects of Betaf-Agonists on Airway Inflammation 67 Peter Howarth I II Mucosal Inflammation and Asthma P2-Agonist-Mediated Effects Relevant to Asthmatic Inflammation In Vitro Studies Ronald Dahl

4 xiii 5. Pharmacokinetics of Beta 2 -Adrenoceptor-Stimulating Drugs 87 Lars Nyberg I II V Analytical Methods Routes of Administration Common Pharmacokinetic Characteristics of P2-Agonists Pharmacokinetics of Individual p 2 -Agonists Mechanisms of Duration of Action of Inhaled Long-Acting Beta 2 -Adrenoceptor Agonists 131 Klaus F. Rabe and Anders Linden I II V VI VII Physicochemical Properties of Formoterol and Salmeterol Animal Airways Human Airways Hypothesis on Long Duration of Action Interactions with the Cell Membrane of Airway Smooth Muscle Role of Non-p-Adrenoceptor-Mediated Relaxation? Gary P. Anderson Bronchodilatation 161 Eric Derom and Romain Pauwels 161 I Mechanisms Underlying the Bronchodilating Action 162 II Oral and Parenteral Administration of p2-agonists 162 Inhalation of p 2 -Agonists 164 Comparison Between Bronchodilating Capacity of P2-Agonists and Other Bronchodilating Drugs 169 V Combination of Short-Acting P2-Agonists with Other Drugs Dirkje S. Postma 176

5 xiv 8. Effects of Beta 2 -Agonists on Airway Responsiveness and Allergen-Induced Responses 179 PaulM. I II V VI VII O'Byrne Airway Hyperresponsiveness in Asthma Effects of Inhaled P2-Agonists on Airway Responsiveness Allergen-Induced Airway Responses Effects of p 2 -Agonists on Allergen-Induced Responses Effects of Regular Use of Inhaled P2-Agonists Tachyphylaxis to Functional Antagonism Eric Derom Effect of Beta-Adrenergic Agonists on Cough and Mucociliary Clearance Kian Fan Chung I II Cough Mucociliary Clearance Jan-Anders Karlsson Inhalation Technique and Inhalation Devices Myrna Dolovich I II V Physical Characteristics of Aerosols Components of the Inhalation Technique Methods to Improve Inhalation Technique Patient Instruction in the Use of Inhalers Lars Borgstrom Adverse Effects of Beta 2 -Agonists 257 CarlD. Burgess, Richard Beasley, Julian Crane, and Neil Pearce 257 I Acute Pharmacological Changes 258

6 xv II Asthma Mortality and Inhaled p-agonists 258 Chronic Adverse Effects: Increase in Asthma Severity Kenneth R. Chapman Clinical Studies of Beta-Agonists in Adults 283 A. E. Tattersfield 283 I Shorter-Acting p-agonists 284 II Longer-Acting P-Agonists Malcolm R. Sears 305 Kenneth R. Chapman Clinical Studies of Beta 2 -Adrenergic Agonists in Children 319 F. Estelle R. Simons I II Chronic Asthma Acute Asthma Additional Safety Issues Regarding p 2 -Adrenergic Agonists in Children Andrea von Berg Tolerance with Beta 2 -Agonists: A Clinical Problem? 349 Brian Jonathon Lipworth, 349 I Requisites for Clinical Studies 350 II Studies with Short-Acting p 2 -Agonists 350 Studies with Long-Acting p 2 -Agonists Peter J. Sterk 361

7 xvi 15. Role of Beta 2 -Agonists in the Treatment of Asthma in Adults 367 Romain Pauwels 367 I Inhaled Sympathomimetics in the Chronic Treatment of Asthma 367 II Inhaled Sympathomimetics in the Treatment of Acute Acute Severe Asthma 370 Place of Oral p 2 -Agonists in the Treatment of Asthma Albert L. Sheffer The Role of Beta 2 -Agonists in the Treatment of Asthma in Children 379 S0ren Pedersen I II V VI Author Index Subject Index Acute Severe Asthma Reversal of Acute Bronchoconstriction Inhibition of Acute Bronchoconstriction Chronic Treatment of Symptoms Modes of Administration James P. Kemp