Chiesi Farmaceutici is fully committed to the care and improvement of the quality of life of people suffering from respiratory diseases including asthma and COPD (Chronic Obstructive Pulmonary Disease). Asthma and COPD are characterised by a reduction in the respiratory flow although they are driven by a different pathophysiological pathway.
According to the latest estimates of the WHO (World Health Organisation), there are 235 million people across the globe – mainly children - suffering from asthma, whilst 64 million people suffering from COPD (WHO 2004 estimate), which is predicted as being the third leading cause of mortality by 2030. If measures aimed at reducing disease-related risk factors – i.e. cigarette smoke - are not adopted, it is estimated that COPD-related deaths will increase by 30% in the next 10 years1.
In the search for continued improvement in the health of patients, Chiesi Farmaceutici researches and develops new therapeutic solutions based on the innovative formulation technology Modulite®, which allows the creation of spray solutions (pMDI, pressurised Metered Dose Inhaler) for inhalation able to deliver extra-fine particles. Chiesi Farmaceutici has patented and introduced into the market a dry powder-based medical device for inhalation (DPI, dry powder inhaler), which is also able to deliver extra-fine particles.
ASTHMA AT A GLANCE
Asthma is a chronic inflammatory disease characterised by recurrent respiratory symptoms such as breathlessness, cough and wheezing as well as chest tightness. In normal conditions, the air is free to move within our lungs through a complex conductive system also called airways. In specific conditions and when asthmatic patient conditions are uncontrolled, the airways are more prone to inflammation, triggering an asthma attack. As a consequence, several changes occur including bronchoconstriction, thickening of the internal mucosa and plugging of small airways, which in turn make breathing more difficult. However, these clinical manifestations are basically reversible, although varying greatly over time or between patients. Generally, the asthmatic status tends to deteriorate during the night or the early hours of the morning. Although it is not possible to recover from asthma, optimal disease control is achievable, ensuring patients maintain an adequate quality of life. But what causes asthma? An asthmatic attack is triggered when a susceptible person comes into contact with irritants. In particular, predisposing factors are genetic (which explains greater incidence in those related to sufferers), the presence of allergies, female gender, obesity and ethnic origin. At the same time, factors such as allergens, professional pollutants, tobacco smoke, environmental pollution and airway infections may trigger an asthmatic attack if inhaled in significant quantities. Asthma occurs more frequently in children and adolescents, although in recent years diagnosis in adults and the elderly are becoming more and more frequent.2
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AT A GLANCE
COPD is a respiratory disease characterised by a persistent bronchial obstruction (irreversible), associated with an increased chronic inflammatory response of the airways to noxious particles or gas. The classic symptoms associated with COPD are dyspnoea, chronic coughing and chronic productive sputum. In some cases, an acute worsening of the abovementioned symptoms may occur, triggering COPD exacerbation. A double mechanism is at work in the bronchial obstruction in COPD patients: on one hand, an inflammation of the small airways together with the thickening of the airways walls and increased airflow resistance may occur. On the other, a progressive destruction of lung parenchyma (emphysema) associated with the loss of elastic retraction of the lung may take place. It is important to underline that both mechanisms may coexist, leading to a global airflow reduction throughout the lungs. But what are the risk factors associated with COPD? First of all, there are genetic risk factors that may predispose some subjects to developing the disease. The most important risk factor is cigarette smoke, as well as exposure to domestic pollutants (linked to the cooking of food or gas emitted from biofuel combustion) or environmental pollution. Secondary factors are age, sex, socio-economic status, respiratory infections, asthma or chronic bronchitis. In general, COPD patients are more prone to developing cardiovascular diseases, osteoporosis, diabetes, lung cancer and bronchiectasis, which in turn increase hospitalisation and/or risk of death. Unlike asthma, COPD is a late onset disease, being more common among adults (it does not exist among young patients), since its development involves a slow and progressive exposure to risk factors.3
Foster® Spray & Foster® NEXThaler®
This is a fixed combination for inhalation of beclomethasone dipropionate (anti-inflammatory) plus formoterol fumarate (bronchodilator). The spray-formulated product (pMDI, Modulite®) releases extra-fine particles. The product is indicated for the treatment of asthma both as a maintenance (1 or 2 puffs twice-daily) and MART (Maintenance and Reliever Therapy) posology scheme. The latter allows the use of Foster also as reliever therapy (6 extra puffs as needed). Foster Spray has also recently obtained marketing authorisation for the COPD indication. The product was launched in Germany in 2006 and is currently commercialised in more than 35 countries around the globe, including Russia and China; additional launches are planned during 2014.
Foster is also available on the market as a dry powder formulation (DPI) for inhalation, dispensed in extra-fine particles by the NEXThaler® device.
Foster is indicated for the maintenance treatment of asthma and COPD.
This is a Modulite®-based spray formulation (pMDI) of formoterol fumarate, a long-acting β2 agonist (LABA) and bronchodilator. Atimos is indicated for the prevention and treatment (1-2 puffs twice-daily) of the bronchospasm in patients with obstructive pulmonary disease, including bronchial asthma and COPD, as well as allergen or cold-induced bronchospasm, in both adults and children over 6.
The Clenil brand includes a range of beclomethasone-containing products, a corticosteroid, in a variety of formulations indicated for a range of inflammation-driven respiratory diseases, including asthma, allergic rhinitis and bronchostenosis conditions: Clenil Spray (pMDI, Modulite®), Clenil A (sterile suspension for nebulisation), Rinoclenil (nasal spray, suspension).
RHEUMATIC AND MUSCULOSKELETAL DISEASES
Rheumatoid arthritis is an autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated.
The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (turgescence) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium. The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis (fusion) of the joints.
Onset is uncommon under the age of 15 and from then on the incidence rises with age until the age of 80. Women are affected three to five times as often as men.
Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton, with variable involvement of peripheral joints and non-articular structures. AS is a member of the group of the spondyloarthropathies, with a strong genetic predisposition. It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine. Complete fusion results in a complete rigidity of the spine, a condition known as "bamboo spine". It usually begins in the second or third decade of life and has male preponderance.
The etiology of AS is unknown, but a combination of genetic and environmental factors work together to produce the clinical disease.
The outcome in patients with AS is generally good compared to that in patients with a disease such as rheumatoid arthritis.
Osteoarthritis, more commonly known as arthrosis, is the most common form of arthritis and affects millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of bones wears down over time.
While osteoarthritis can damage any joint in the human body, the disorder most commonly affects joints in the hands, neck, lower back, knees and hips.
Osteoarthritis gradually worsens with time, and no cure exists. However, osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.
Brexin (Piroxicam β-cyclodextrin) is a non-steroidal anti-inflammatory drug indicated for the symptomatic treatment of painful and inflammatory conditions in patients suffering from rheumatoid arthritis, ankylosing spondylitis and osteoarthritis, with a once-daily posology.
Cardiovascular diseases (CVD) are the number one cause of death globally: more people die annually from CVDs than from any other cause.
CVD refers to any disease that affects the cardiovascular system, principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease. The causes of CVD are diverse but atherosclerosis and/or hypertension are the most common. In addition, with ageing come a number of physiological and morphological changes that alter cardiovascular function and lead to an increased risk of CVD, even in healthy asymptomatic individuals.
In the fight for the prevention of CVDs, the strongest effort focusses on the treatment of hypertension, as it is one of the biggest cardiovascular risk factors. As a matter of fact, it substantially increases the probability of cardio-, cerebral- , and reno-vascular adverse events. Moreover, the possible association with other prominent risk factors, such as hypercholesterolemia, smoking and diabetes, brings about a further significant increase in probability. Therefore, the therapeutic choice must be based on individual global cardiovascular risk calculation, taking into account age, gender, past occurrence of cardiovascular events and presence of other associated risk factors.
Iperten (Manidipine chlorohydrate), a long-lasting calcium-channel blocker, is indicated for the treatment of mild-to-moderate hypertensive patients. Its vasodilatory activity is capable of reducing both systolic and diastolic blood pressure, by means of a once-daily posology.
Vivace is the fixed combination of two antihypertensive agents, manidipine (a calcium-channel blocker) and delapril (an ACE-inhibitor), whose mechanism of action is to inhibit the formation of Angiotensin II, one of the strongest vasoconstrictor mediators. Its indication is the treatment of essential hypertension in patients not adequately controlled with manidipine or delapril monotherapy, with a once-daily posology.