Inhaled bronchodilators with or without inhaled steroids (IGCs) are the mainstay of pharmacological treatment for stable obstructive airway diseases, including beta2-agonists and muscarinic antagonists. Long-acting muscarinic antagonist bronchodilators (LAMA) and long-acting β2-agonists (LABA) are the treatment of choice for moderate to severe chronic obstructive pulmonary disease (COPD). Also some studies have demonstrated the benefit of LAMA in the treatment of difficult-to-control asthma and the potential use in asthma-COPD overlap (ACO). Control of airway tone in health and disease states, cholinergic and adrenergic receptors, signaling, molecular biology of mediators, and airway muscle contraction / relaxation mechanisms are reviewed concisely and as they may be handled pharmacologically. Subsequently, the evidence of the role of the LABA / LAMA combination in the aforementioned entities, their complementary mechanisms of action and other alternative mechanisms of action as well as potential deleterious effects is discussed.
Alcibey Alvarado Internal Medicine and Neumology, Clínica de Diagnóstico Médico, San José, Costa Rica.
It is estimated that there will be an increase in the incidence of chronic obstructive pulmonary disease (COPD) in the coming decades. Thus, the pharmacological attributes of products of plant origin should be considered as an important economic and scientific strategy in the investigation of therapeutic alternatives, since their experimental validations are indispensable to substantiate the reliability of these products in the treatment of chronic diseases. Like biologically active compounds, Eucalyptol, also known as 1,8- cineole, is the major constituent of the leaf oil of eucalyptus species, such as Eucalyptus globulus and Eucalyptus tereticornis. It is a terpenoid oxide, free of steroid-like side effects. This study is based on a review of the specialised literature with purpose to discuss the biological effects of Eucalyptol in the respiratory system and its interaction with some of the most promising targets in the treatment of COPD, such as: receivers and membrane channels, oxidative stress, transcription and expression of cytokines, cell adhesion molecules and neutrophil chemotaxis, proteases and remodeling.
Fladimir de Lima Gondim Postgraduate Program in Physiological Sciences, State University of Ceará, Ceará, Brazil.
Gilvan Ribeiro dos Santos Center of Technological Sciences, State University of Ceará, Ceará, Brazil.
Daniel Silveira Serra Center of Technological Sciences, State University of Ceará, Ceará, Brazil.
Francisco Sales Ávila Cavalcante Center of Technological Sciences, State University of Ceará, Ceará, Brazil.