Treatment of airway mucus hypersecretion

Airway mucus hypersecretion is now recognized as a key pathophysiological feature in many patients with asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis. Consequently, it is important to develop drugs that inhibit mucus hypersecretion in these susceptible patients. Conventional therapies, including anticholinergics, β2‐adrenoceptor agonists, corticosteroids, mucolytics and macrolide antibiotics, have variable efficacy in inhibiting airway mucus hypersecretion, and are less effective in COPD than in asthma. Novel pharmacotherapeutic targets are being investigated, including inhibitors of nerve activity (e.g. large conductance calcium‐activated potassium, BKCa, channel activators), tachykinin receptor antagonists, epoxygenase inducers (e.g. benzafibrate), inhibitors of mucin exocytosis (e.g. anti‐myristoylated alanine‐rich C kinase substrate (MARCKS), peptide and Munc‐18B blockers), inhibitors of mucin synthesis and goblet cell hyperplasia (e.g. epidermal growth factor (EGF), receptor tyrosine kinase inhibitors, p38 mitogen‐activated protein (MAP), kinase inhibitors, MAP kinase kinase/extracellular signal‐regulated kinase (MEK/ERK), inhibitors, human calcium‐activated chloride (hCACL2), channel blockers and retinoic acid receptor‐α antagonists), inducers of goblet cell apoptosis (e.g. Bax inducers or Bcl‐2 inhibitors), and purinoceptor P2Y2 antagonists to inhibit mucin secretion or P2Y2 agonists to hydrate secretions. However, real and theoretical differences delineate the mucus hypersecretory phenotype in asthma from that in COPD. More information is required on these differences to identify specific therapeutic targets which, in turn, should lead to rational design of anti‐hypersecretory drugs for treatment of airway mucus hypersecretion in asthma and COPD.