呼吸器医学ジャーナル

Emerging landscape in the management of acute exacerbations of chronic obstructive pulmonary disease (COPD): Role of Pidotimod

Pradyut Waghray

The burden of chronic obstructive pulmonary disease (COPD) is estimated to be amongst the highest in the world. A recent study indicates that the number of COPD cases in India increased from 28·1 million in 1990 to 55·3 million in 2016. The correlation between immune dysfunction and chronic respiratory diseases such as COPD is well established. COPD is characterized by chronic inflammation of the airway which compromises innate as well as adaptive immune responses. This predisposes the patients to infective exacerbations of COPD. Addition of an immunostimulant agent in the treatment of COPD and AECOPD can be very effective. Pidotimod is a synthetic dipeptide molecule having immunostimulant properties and exerting effects on both innate and adaptive immunity. Pidotimod induces dendritic cells (DCs) maturation, promotes phagocytosis, upregulates expression of toll-like receptors-2 (TLR-2), stimulates T cell proliferation towards Th1 phenotype and enhances function of natural killer (NK) cells. As per one recent study in immunology, functional disorder of Th1/Th2 cells and immune hypofunction is clearly linked to development of recurrent respiratory tract infections (RRTIs). Pidotimod has been extensively studied in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in adults. Robust clinical evidence indicates that Pidotimod, when added to the standard of care reduces the number of exacerbations of COPD, shortens recovery time and reduces duration of clinical symptoms of AECOPD as compared to standard of care alone. Various studies conducted to date have demonstrated excellent safety profile of the molecule. A recent study by Goyal A concluded that Pidotimod is effective, well tolerated and cost effective for prevention and treatment of acute exacerbations of COPD. Hence, addition of an immunostimulant such as Pidotimod in management of these conditions can be very effective. To conclude, Pidotimod is a safe, well tolerated and effective therapeutic option in the treatment and prevention of AECOPD.