COPD Management with Corticosteroids Assessment Answer

Introduction

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition that involves persistent airflow limitation and airway inflammation. This respiratory disorder is considered one of the main causes of illness and mortality around the world, putting a significant strain on both individuals and healthcare systems (AstraZeneca, 2021). The treatment of COPD involves a variety of strategies, and corticosteroids have been crucial in reducing symptoms and avoiding exacerbations (Quint et al., 2023). In this study, the pharmacology, mechanism of action, pharmacokinetic profile, toxicity, side effects, indications, contraindications as well as clinical applications associated with the class of drug, corticosteroids are discussed in order to comprehend the significance of it in COPD management.

Pharmacology

Corticosteroids, a class of drugs is referred to as synthetic drugs as they are created to act similarly to the hormone cortisol, which is naturally produced by the adrenal glands. This class of medications is integral to COPD management due to their potent anti-inflammatory properties (Izquierdo & Cosio, 2018). When corticosteroids bind to particular cytoplasmic receptors in target cells, they exert their pharmacological effects and initiate a chain reaction of biological responses that ultimately lead to their therapeutic impact (Cataldo et al., 2018). Budesonide is one of the active components which belongs to this particular class of drugs known as corticosteroids. This component exerts its anti-inflammatory effects on the airways (Higham et al., 2018). Budesonide reduces the inflammation and swelling of the air passages in COPD, thereby alleviating symptoms along with improving lung function (Klitgaard et al., 2023). Budesonide works synergistically with Formoterol fumarate and glycopyrronium to provide COPD patients with long-term relief from bronchial constriction and enhanced lung function (Liu et al., 2022). Several other corticosteroids are extensively employed to mitigate the symptoms and reduce the frequency of exacerbations (Izquierdo & Cosio, 2018). Among the most widely used corticosteroids in clinical practice are prednisone, prednisolone, and dexamethasone. Although the clinical uses and pharmacokinetic profiles of these medications differ, they all share basic pharmacological characteristics that make them acceptable for a range of therapeutic situations in the therapy of COPD (Hasan et al., 2020).

The significant anti-inflammatory effects of corticosteroids constitute the bedrock of COPD treatment. Inflammation is a defining feature of COPD, which is characterized by immune cell infiltration into the airways and lung tissue, resulting in bronchoconstriction, mucus hypersecretion, and tissue destruction (Hasan et al., 2020). This particular drug class, corticosteroids inhibit the production of pro-inflammatory cytokines, such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) (Hasan et al., 2020). It can be said that this class of drugs acts to suppress the production and release of inflammatory mediators that contribute to airway inflammation like cytokines and prostaglandins (Zhang et al., 2020). The infiltration and activation of inflammatory cells, such as macrophages and neutrophils, into the airways and lung tissue is also decreased by corticosteroids (Hasan et al., 2020). By reducing inflammation, corticosteroids help alleviate symptoms, prevent exacerbations, along with improve the function of the lungs in certain conditions like asthma and COPD.

Mechanism of Action

The anti-inflammatory characteristics of corticosteroids are principally responsible for their therapeutic effectiveness in the therapy of COPD (Samuel et al., 2017). Corticosteroids work by modulating the inflammatory response at multiple levels:

Inhibition of pro-inflammatory cytokines: The immune response is significantly affected by Corticosteroids thereby reducing the generation of cytokines inducing inflammation (Samuel et al., 2017). These cytokines, including tumor necrosis factor-alpha (TNF-), interleukin-1 (IL-1), and interleukin-6 (IL-6), are important mediators of inflammation in COPD (Samuel et al., 2017). Corticosteroids effectively reduce the early inciting factors of the inflammatory cascade by lowering the amounts of these cytokines (Samuel et al., 2017). This cytokine-level suppression helps to reduce airway inflammation and the related negative effects on lung function (Cataldo et al., 2018).

Reducing immune cell recruitment: The immune cells like neutrophils and macrophages migrated and activated away from the airways and lung tissue are reduced primarily by this particular class of drugs (Samuel et al., 2017). These immune cells are the distinguishing characteristic of inflammation in COPD. Due to their anti-inflammatory effects, corticosteroids block the chemotaxis and adhesion mechanisms that draw these cells to the area of inflammation (Sato et al., 2017). As a result, the lower inflow of immune cells causes less inflammation and mitigates COPD-related airway constriction and mucus hypersecretion. In basic terms, corticosteroids block the creation of different pro-inflammatory proteins by acting directly at the genetic level. The overall anti-inflammatory benefits of corticosteroids in COPD are further enhanced by this complex inhibition of inflammatory gene transcription (Cataldo et al., 2018).

Suppressing inflammatory gene transcription: The distinctive property of corticosteroids is their capacity to enter the nucleus of target cells and bind to DNA's glucocorticoid response elements (GREs) (Hasan et al., 2020). This interaction acts as a master switch to stop the transcription of genes that promote inflammation (Cataldo et al., 2018).

Stabilizing cell membranes: The release of lipocortin-1, a protein that is essential for reducing inflammation, has been facilitated by corticosteroids (Hasan et al., 2020). In order to exert its effects, lipocortin-1 inhibits the activity of phospholipase A2, an enzyme that produces the inflammatory mediators prostaglandins and leukotrienes (Klitgaard et al., 2023). These inflammatory mediators have the ability to significantly increase bronchoconstriction, mucus formation, and vascular permeability (Hasan et al., 2020). All these important factors contribute the characteristic symptoms of COPD. Corticosteroids significantly decrease the generation of prostaglandins and leukotrienes by inhibiting phospholipase A2, hence reducing their inflammatory effects on the airways (Samuel et al., 2017).

Pharmacokinetic Profile

Corticosteroids demonstrate rapid absorption upon inhalation, primarily targeting the airways where inflammation is prominent in COPD (Heo, 2021). It can be administered through various routes, including oral, inhaled, and intravenous. When delivered directly to the lungs, inhaled corticosteroids (ICS), which are frequently used to treat COPD, have good absorption, limiting systemic effects (Tashkin et al., 2019). Depending on the mode of administration, corticosteroids require a different amount of time to reach their peak plasma concentrations (Tashkin et al., 2019). As opposed to oral corticosteroids, which have a slow absorption across the body and less systemic exposure, inhaled corticosteroids have lower peak plasma concentrations and a decreased risk of systemic side effects (Tashkin et al., 2019). However, when inhaled, the peak plasma concentrations of corticosteroids typically reach the lungs within 1-2 hours (Higham et al., 2018). Corticosteroids is distributed primarily in the lung tissue. It has a low volume of distribution, suggesting that it stays mainly in the lungs, which is desirable for a medication used to treat respiratory conditions (Samuel et al., 2017). The dosage, duration, route of administration, and specific medication all affect the safety profile of corticosteroids utilized to treat COPD.

Toxicity and Side Effects

Inhaled corticosteroids (ICS) are often prescribed to treat COPD in order to reduce airway inflammation and prevent exacerbations (Tashkin et al., 2019). Although ICS are usually regarded as being less likely to cause systemic side effects than their oral counterparts, they can still have toxicity and side effects, particularly when administered incorrectly or at high doses. One of the most common local side effects of inhaled corticosteroids is oral thrush, a fungal infection in the mouth (Zhang et al., 2020). ICS can suppress the immune response in the oral cavity, allowing for the overgrowth of Candida fungus (Zhang et al., 2020). Inhaled corticosteroids like Budesonide can sometimes lead to hoarseness or voice changes (Zhang et al., 2020). This side effect is usually mild and can be managed by using a spacer with the inhaler and practicing good inhaler technique (Higham et al., 2018). In addition, some individuals may experience a cough or throat irritation when using corticosteroids (Zhang et al., 2020). Such type of side-effect diminishes with continued use, but it's essential to ensure proper inhaler technique to minimize throat exposure (Samuel et al., 2017). Additionally, it can also be said that long-term use of high-dose ICS in COPD has been associated with a slightly increased risk of pneumonia.

Clinical Applications

Inhaled corticosteroids (ICS), such as Budesonide, hold specific clinical applications for managing chronic obstructive pulmonary disease (COPD) (AstraZeneca, 2021). COPD is a devastating lung disease that causes chronic inflammation, bronchoconstriction, and reduced lung function (AstraZeneca, 2021). Inhaled corticosteroids (ICS) is critical in the long-term maintenance treatment of COPD, providing a diverse strategy to deal with its multiple characteristics (Tashkin et al., 2019). One of the primary purposes of COPD management is to reduce symptoms, improve lung function, and reduce the likelihood of exacerbations (Klitgaard et al., 2023). ICS is commonly used in combination with long-acting beta-agonists (LABAs) as part of dual therapy such as Budesonide and formoterol fumarate (Lungfoundation, 2023). It can be said that by this drug combination is highly recommended for patients with COPD who remain symptomatic or experience exacerbations despite using a long-acting bronchodilator alone.

While COPD remains the main emphasis, the drug class corticosteroids might play a role in severe asthma situations. Airway inflammation and bronchoconstriction are two pathophysiological hallmarks shared by severe asthma and COPD (Tashkin et al., 2019). Corticosteroids’ unique blend of components may offer an alternate approach to symptom management and enhanced lung function in these specific circumstances where standard asthma treatments may be insufficient (Tashkin et al., 2019).

Conclusion

It is acknowledged throughout the study that this particular class of drugs, corticosteroids provide a revolutionary development in the treatment of Chronic Obstructive Pulmonary Disease (COPD). This drug class is said to be essential for reducing symptoms, preventing exacerbations, along with enhancing lung function due to their strong anti-inflammatory effects and capacity to control several inflammatory response factors. However, especially when used in long-term or high-dose therapy, their use must be carefully weighed with any potential negative effects. Each COPD patient's unique needs should guide the selection of the corticosteroid type, delivery method, and dosage, with an emphasis on optimizing therapeutic benefits while lowering potential hazards. Effective COPD management utilizing corticosteroids requires careful monitoring and frequent follow-up.

References

AstraZeneca, (2021). AstraZeneca announces new treatment will be listed on the PBS from November 1st, 2021 to help manage COPD, Australia’s fifth leading cause of death. AstraZeneca . https://www.astrazeneca.com.au/news/media-releases/2021/astrazeneca-announces-new-treatment-will-be-listed-on-the-pbs.html#:~:text=SYDNEY%20AUSTRALIA%2C%2030%20OCTOBER%202021,will%20be%20listed%20on%20the

Cataldo, D., Derom, E., Liistro, G., Marchand, E., Ninane, V., Peché, R., ... & Janssens, W. (2018). Overuse of inhaled corticosteroids in COPD: five questions for withdrawal in daily practice. International journal of chronic obstructive pulmonary disease, 2089-2099. https://doi.org/10.2147/COPD.S164259

Ferguson, G. T., Darken, P., Ballal, S., Siddiqui, M. K., Singh, B., Attri, S., ... & de Nigris, E. (2020). Efficacy of budesonide/glycopyrronium/formoterol fumarate metered dose inhaler (BGF MDI) versus other inhaled corticosteroid/long-acting muscarinic antagonist/long-acting β 2-agonist (ICS/LAMA/LABA) triple combinations in COPD: a systematic literature review and network meta-analysis. Advances in Therapy , 37, 2956-2975. https://doi.org/10.1007/s12325-020-01311-3

Hasan, S. S., Capstick, T., Zaidi, S. T. R., Kow, C. S., & Merchant, H. A. (2020). Use of corticosteroids in asthma and COPD patients with or without COVID-19. Respiratory Medicine , 170, 106045. https://doi.org/10.1016/j.rmed.2020.106045

Heo, Y. A. (2021). Budesonide/glycopyrronium/formoterol: a review in COPD. Drugs , 81, 1411-1422. https://doi.org/10.1007/s40265-021-01562-6

Higham, A., Karur, P., Jackson, N., Cunoosamy, D. M., Jansson, P., & Singh, D. (2018). Differential anti-inflammatory effects of budesonide and a p38 MAPK inhibitor AZD7624 on COPD pulmonary cells. International Journal of Chronic Obstructive Pulmonary Disease , 1279-1288. https://doi.org/10.2147/COPD.S159936

Izquierdo, J. L., & Cosio, B. G. (2018). The dose of inhaled corticosteroids in patients with COPD: when less is better. International Journal of Chronic Obstructive Pulmonary Disease , 3539-3547. https://doi.org/10.2147/COPD.S175047

Katsumata, M., Fujisawa, T., Kamiya, Y., Tanaka, Y., Kamiya, C., Inoue, Y., ... & Suda, T. (2022). Effects of long-acting muscarinic antagonists on promoting ciliary function in airway epithelium. BMC Pulmonary Medicine , 22(1), 1-14. https://doi.org/10.1186/s12890-022-01983-3

Klitgaard, A., Ibsen, R., Hilberg, O., & Løkke, A. (2023). Study protocol: pneumonia and inhaled corticosteroid treatment patterns in chronic obstructive pulmonary disease–a cohort study using sequence analysis (PICCS). BMJ Open , 13(6), e072685. http://dx.doi.org/10.1136/bmjopen-2023-072685

Liu, H., Wang, Z., Ren, L., Zhang, G., Zhao, D., Guo, Y., ... & Feng, H. (2022). Clinical Efficacy of Budesonide/Glycopyrronium Bromide/Formoterol in the Treatment of Patients with Acute Respiratory Distress Syndrome and Its Effect on Inflammatory Factors. Evidence-Based Complementary and Alternative Medicine , 2022. https://doi.org/10.1155/2022/8150444

Lungfoundation (2023). Inhalers for Chronic Obstructive Pulmonary Disease (COPD). https://lungfoundation.com.au/wp-content/uploads/2023/02/Poster_COPD-Inhaler-Chart_Feb2023.pdf

Quint, J. K., Ariel, A., & Barnes, P. J. (2023). Rational use of inhaled corticosteroids for the treatment of COPD. NPJ Primary Care Respiratory Medicine , 33(1), 27. https://doi.org/10.1038/s41533-023-00347-6

Samuel, S., Nguyen, T., & Choi, H. A. (2017). Pharmacologic characteristics of corticosteroids. Journal Of Neurocritical Care , 10(2), 53-59. https://doi.org/10.18700/jnc.170035

Sato, J., Uchida, T., Komiya, K., Goto, H., Takeno, K., Suzuki, R., ... & Watada, H. (2017). Comparison of the therapeutic effects of prednisolone and nonsteroidal anti-inflammatory drugs in patients with subacute thyroiditis. Endocrine , 55, 209-214. https://doi.org/10.1007/s12020-016-1122-3

Tashkin, D. P., Lipworth, B., & Brattsand, R. (2019). Benefit: risk profile of budesonide in obstructive airways disease. Drugs , 79(16), 1757-1775. https://doi.org/10.1007/s40265-019-01198-7

Wang, Y., Xu, J., Meng, Y., Adcock, I. M., & Yao, X. (2018). Role of inflammatory cells in airway remodeling in COPD. International Journal of Chronic Obstructive Pulmonary Disease , 3341-3348. https://doi.org/10.2147/COPD.S176122

Zhang, Q., Li, S., Zhou, W., Yang, X., Li, J., & Cao, J. (2020). Risk of pneumonia with different inhaled corticosteroids in COPD patients: a meta-analysis. COPD: Journal of Chronic Obstructive Pulmonary Disease , 17(4), 462-469. https://doi.org/10.1080/15412555.2020.1787369

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