New bronchodilators

Bronchodilators are central in the treatment of airway diseases including chronic obstructive pulmonary disease (COPD). Bronchodilators in COPD aim to improve lung function, reduce symptoms, prevent exacerbation, and enhance quality of life. The majority of programs in development for novel bronchodilators are focused on enhancing existing targets to once daily dosing and improving their safety profiles. However, just as important are other programs that aim to discover novel pharmacologic targets such as EP4 receptor agonists, bitter taste receptors, and selective PDE inhibitors. Furthermore, existing and novel bronchodilators have become vital components of multiple combination therapies targeting COPD. This review will discuss emerging bronchodilators highlighting preclinical data and available clinical trials.

► Indacaterol is the first ultra-LABA approved for use in treatment of COPD. ► Novel long acting antimuscarinic bronchodilators may be dosed once or twice daily. ► Novel xanthines are being studied as add-on agents to maintenance therapy. ► EP4 receptor agonists, bitter taste receptors and dual PDE3/PDE4 are novel targets. ► Combination bronchodilator therapy simplifies dosing and improves drug efficacy.