Neue pharmakologische Ansätze in der Therapie der COPD

Zusammenfassung

Die chronisch obstruktive Bronchitis und das Lungenemphysem (chronic obstructive pulmonary disease; COPD) sind durch eine nicht vollständig reversible Verminderung des Atemflusses charakterisiert, die progredient ist und mit einer abnormen Entzündungsreaktion einhergeht. Die primär pulmonale Erkrankung wird in ihrem Verlauf durch systemische Manifestationen mitbestimmt. Da die Krankheit ursächlich auf das inhalative Rauchen zu beziehen ist, führt die Nikotinkarenz zu einer symptomatischen und prognostischen Besserung. Die wirksamste verfügbare Pharmakotherapie stellen die Bronchodilatatoren dar, deren Applikation und Wirkdauer gegenwärtig verbessert wird. Die Beeinflussung der charakteristischen pulmonalen Entzündung, die bei der COPD in den Atemwegen, dem Lungenparenchym und den Lungengefäßen nachweisbar ist, wird gegenwärtig mit einer Vielfalt von pharmakologischen Ansätzen untersucht. Die systemische Inflammation, die die COPD begleitet, ist ebenfalls eine Zielgröße der medikamentösen Therapie. Die Beurteilung der vielfältigen therapeutischen Ansätze wird dadurch erschwert, dass der gebräuchliche funktionelle Parameter der Schwere der COPD, FEV_1.0, den Nutzen der Therapie nur unvollständig beschreibt. Die erfolgversprechende Entwicklung neuer therapeutischer Ansätze muss daher mit einem besseren Verständnis der für die COPD relevanten Zielgrößen einhergehen.

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible, mostly progressive and associated with an abnormal inflammatory reaction. The course of this pulmonary disease is influenced by systemic inflammation and comorbidities. COPD is caused by inhaled gases and particles and therefore avoidance of inhalative smoking results in symptomatic relief and improvement of the course of the disease. Modulation of the characteristic pulmonary inflammation, which is present in airways, parenchyma and pulmonary vasculature is targeted by a variety of novel pharmacological approaches. Systemic inflammation associating COPD should also be influenced to improve the disease. Assessment of the benefits of these approaches is difficult since FEV_1.0 as the most popular marker to describe the functional severity of COPD does not always reflect the benefits of the novel therapeutic strategies. Therefore new therapeutic modalities must be paralleled by the development of new clinical relevant targets.

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