MEDizzy - A 45-year-old man had been suffering from chronic

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Drugs for Bronchospastic Disorders

A 45-year-old man had been suffering from chronic obstructive pulmonary disease that was not adequately controlled by inhaled salmeterol and ipratropium. His physician decided to add a third drug that is thought to act by multiple mechanisms, including inhibition of phosphodiesterase 4 in inflammatory cells and enhancement of histone deacetylation. Which of the following drugs was most likely added to the patient’s therapeutic regimen?

ExplanationThe antiasthmatic action of theophylline seems to result from both bronchodilating and nonbronchodilating actions. The inhibition of phosphodiesterase 4 (PDE4) in smooth muscle most likely explains the bronchodilating activity. Proposed nonbronchodilating mechanisms involve inhibition of PDE4 in inflammatory cells, which most likely reduces the release of inflammatory cytokines and enhances histone deacetylation (acetylation of histone is needed for activation of inflammatory gene transcription).