ABSTRACT
Chronic obstructive pulmonary disease (COPD) is the most common of all respiratory
disorders and the prevalence of diagnosed disease is growing at an alarming rate (1)
(see Chapter 1, “The Burden of Chronic Obstructive Pulmonary Disease,” for more
information). Acute exacerbations of COPD are a major concern due to an adverse
effect on health status and increased mortality; indeed, it has been estimated that 10% to
30% of the most severely afflicted will die following hospitalization (2). Long-term
survival rates after an exacerbation are also poor (3). The World Health Organization
predicts that because of the increased prevalence and poor treatment, COPD will
become the third most common cause of death worldwide by 2020 and exact an
enormous economic burden (4). Despite this impending epidemic no drugs, including
glucocorticoids, have a major impact on the progression of any aspect of COPD (cf.
asthma) (5,6). Thus, while smoking cessation intervention reduces the decline in lung
function and, along with bronchodilators, provides symptomatic relief, there are unmet
needs for patients with COPD, including anti-inflammatory therapy allied with drugs
that improve lung function, reduce excessive mucus secretion, arrest remodeling, and
normalize airways reactivity. Many new drugs, some with a novel or an unproven
mechanism of action, are in development (Table 1). The primary purpose of this
chapter to review the clinical data thus far obtained with new chemical entities (NCEs)
in late Phase development for COPD that have a realistic chance of reaching the
market, specifically, phosphodiesterase (PDE) 4 inhibitors and new mucolytics.
In addition, brief mention will be made of novel pharmacotherapeutic approaches that,
in the author’s opinion, also offer potential promise for the effective treatment of COPD
but where development is not so (clinically) advanced.
