Emerging drugs for chronic obstructive pulmonary disease.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major public health problem with increasing morbidity and mortality. It is characterized by airflow obstruction that is usually progressive, not fully reversible and does not change markedly over several months. It is associated with an enhanced inflammatory response in the airways and the lung to noxious particles or gases. Therefore, bronchial relaxation and inflammatory response suppression represent a mechanistic approach to the treatment of COPD. AREAS COVERED: This review article is focused on emerging treatment for COPD that is mainly based on new bronchodilators and anti-inflammatory drugs. We also mention new pharmacologic agents whose mechanisms of action target protease activity at the enzymatic level and the potential regenerative therapy for COPD. EXPERT OPINION: New drugs for the treatment of COPD are greatly needed, but development of novel drugs for COPD has proved to be very difficult. Nevertheless, in these last years, several new potential targets have been identified and novel agents for these new targets, as well for known targets, have been developed. Rational therapy depends on elucidating the cellular and molecular mechanisms that are involved in bronchodilation and inflammation in COPD patients, and the structural changes and aberrant repair mechanisms that characterize the pathophysiology of COPD.