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Role of nebulized glycopyrrolate in the treatment of chronic obstructive pulmonary disease

Authors Santus P, Radovanovic D, Cristiano A, Valenti V, Rizzi M

Received 25 August 2017

Accepted for publication 25 October 2017

Published 15 November 2017 Volume 2017:11 Pages 3257—3271

DOI https://doi.org/10.2147/DDDT.S135377

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Professor Jianbo Sun

Pierachille Santus,1 Dejan Radovanovic,1 Andrea Cristiano,1 Vincenzo Valenti,2 Maurizio Rizzi1

1Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, “L. Sacco” Hospital, ASST Fatebenefratelli Sacco, Milan, Italy; 2Department of Health Bioscience, University of Milan – Respiratory Unit, Policlinico di San Donato, IRCCS – San Donato Milanese, Milan, Italy

Abstract: 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.

Keywords: glycopyrrolate, glycopyrronium, nebulizer, COPD, antimuscarinic, device

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