WO2008096121A1 - Combinations of beta-2-adrenoceptor agonistic benzothiazolone - Google Patents

Abstract

The invention provides a pharmaceutical product, kit or composition comprising a first active ingredient which is N-[2-(Diethylamino)ethyl]-N-(2-{[2-(4-hydroxy-2-oxo-2,3-dihydro-1,3-benzothiazol-7-yl)ethyl]amino}ethyl)-3-[2-(3-chlorophenyl)ethoxy]pro panamide or a salt thereof, and a second active ingredient selected from: a non-steroidal Glucocorticoid Receptor (GR Receptor) Agonist; an antioxidant; a CCR1 antagonist; a chemokine antagonist (not CCR1); a corticosteroid; a CRTh2 antagonist; a DP1 antagonist; an Histone Deacetylase Inducer; an IKK2 inhibitor; a COX inhibitor; a lipoxygenase inhibitor; a leukotriene receptor antagonist; an MPO inhibitor; a muscarinic antagonist; a p38 inhibitor; a PDE inhibitor; a PPARΥ agonist; a protease inhibitor; a Statin; a thromboxane antagonist; a vasodilator; or, an ENAC blocker (Epithelial Sodium-channel blocker); and its use in the treatment of respiratory disease.

Description

COMBINATIONS OF BETA-2-ADRENOCEPTOR AGONISTIC BENZOTHIAZOLONE

The present invention relates to a combination of two or more pharmaceutically active substances for use in the treatment of respiratory diseases (for example chronic obstructive pulmonary disease (COPD) or asthma).

The essential function of the lungs requires a fragile structure with enormous exposure to the environment, including pollutants, microbes, allergens, and carcinogens. Host factors, resulting from interactions of lifestyle choices and genetic composition, influence the response to this exposure. Damage or infection to the lungs can give rise to a wide range of diseases of the respiratory system (or respiratory diseases). A number of these diseases are of great public health importance. Respiratory diseases include Acute Lung Injury, Acute Respiratory Distress Syndrome (ARDS), occupational lung disease, lung cancer, tuberculosis, fibrosis, pneumoconiosis, pneumonia, emphysema, Chronic Obstructive Pulmonary Disease (COPD) and asthma.

Among the most common of the respiratory diseases is asthma. Asthma is generally defined as an inflammatory disorder of the airways with clinical symptoms arising from intermittent airflow obstruction. It is characterised clinically by paroxysms of wheezing, dyspnea and cough. It is a chronic disabling disorder that appears to be increasing in prevalence and severity. It is estimated that 15% of children and 5% of adults in the population of developed countries suffer from asthma. Therapy should therefore be aimed at controlling symptoms so that normal life is possible and at the same time provide basis for treating the underlying inflammation.

COPD is a term which refers to a large group of lung diseases which can interfere with normal breathing. Current clinical guidelines define COPD as a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles and gases. The most important contributory source of such particles and gases, at least in the western world, is tobacco smoke. COPD patients have a variety of symptoms, including cough, shortness of breath, and excessive production of sputum; such symptoms arise from dysfunction of a number of cellular compartments, including neutrophils, macrophages, and epithelial cells. The two most important conditions covered by COPD are chronic bronchitis and emphysema.

Chronic bronchitis is a long-standing inflammation of the bronchi which causes increased production of mucous and other changes. The patients' symptoms are cough and expectoration of sputum. Chronic bronchitis can lead to more frequent and severe respiratory infections, narrowing and plugging of the bronchi, difficult breathing and disability.

Emphysema is a chronic lung disease which affects the alveoli and/or the ends of the smallest bronchi. The lung loses its elasticity and therefore these areas of the lungs become enlarged. These enlarged areas trap stale air and do not effectively exchange it with fresh air. This results in difficult breathing and may result in insufficient oxygen being delivered to the blood. The predominant symptom in patients with emphysema is shortness of breath.

Therapeutic agents used in the treatment of respiratory diseases include corticosteroids. Corticosteroids (also known as glucocorticosteroids or glucocorticoids) are potent antiinflammatory agents. Whilst their exact mechanism of action is not clear, the end result of corticosteroid treatment is a decrease in the number, activity and movement of inflammatory cells into the bronchial submucosa, leading to decreased airway responsiveness. Corticosteroids may also cause reduced shedding of bronchial epithelial lining, vascular permeability, and mucus secretion. Whilst corticosteroid treatment can yield important benefits, the efficacy of these agents is often far from satisfactory, particularly in COPD. Moreover, whilst the use of steroids may lead to therapeutic effects, it is desirable to be able to use steroids in low doses to minimise the occurrence and severity of undesirable side effects that may be associated with regular administration. Recent studies have also highlighted the problem of the acquisition of steroid resistance amongst patients suffering from respiratory diseases. For example, cigarette smokers with asthma have been found to be insensitive to short term inhaled corticosteroid therapy, but the disparity of the response between smokers and non-smokers appears to be reduced with high dose inhaled corticosteroid (Tomlinson et ah, Thorax 2005;60:282-287). A further class of therapeutic agent used in the treatment of respiratory diseases are bronchodilators. Bronchodilators may be used to alleviate symptoms of respiratory diseases by relaxing the bronchial smooth muscles, reducing airway obstruction, reducing lung hyperinflation and decreasing shortness of breath. Types of bronchodilators in clinical use include β₂ adrenoceptor agonists, muscarinic receptor antagonists and methylxanthines. Bronchodilators are prescribed mainly for symptomatic relief and they are not considered to alter the natural history of respiratory diseases.

N-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4-hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol-7- yl)ethyl]amino}ethyl)-3-[2-(3-chlorophenyl)ethoxy]propanamide ditrifluoroacetate is a β2 adrenoceptor agonist and is disclosed in PCT/SE2006/000927 (published as WO 2007/018461). This compound shows at least a 10-fold selectivity of β2 adrenoceptor agonism over adrenergic αlD, adrenergic βl and dopamine D2 activities.

Combination products comprising a β₂ adrenoceptor agonist and a corticosteroid are available. One such product is a combination of budesonide and formoterol fumarate (marketed by AstraZeneca under the tradename Symbicort ®), which has proven to be effective in controlling asthma and COPD, and improving quality of life in many patients.

In view of the complexity of respiratory diseases such as asthma and COPD, it is unlikely that any one mediator can satisfactorily treat the disease alone. Moreover, whilst combination treatments using a β₂ adrenoceptor agonist and a corticosteroid deliver significant patient benefits, there remains a medical need for new therapies against respiratory diseases such as asthma and COPD, in particular for therapies with disease modifying potential.

Accordingly, the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-N-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl]amino } ethyl)-3 - [2-(3- chlorophenyl)ethoxy]propanamide or a salt thereof, and a second active ingredient selected from: a non-steroidal Glucocorticoid Receptor (GR Receptor) Agonist; an antioxidant; a CCRl antagonist; a chemokine antagonist (not CCRl); a corticosteroid; a CRTh2 antagonist; a DPI antagonist; an Histone Deacetylase Inducer; an IKK2 inhibitor; a COX inhibitor; a lipoxygenase inhibitor; a leukotriene receptor antagonist; an MPO inhibitor; a muscarinic antagonist which is Aclidinium bromide, Glycopyrrolate (such as R₃R-, R₅S-, S₅R-, or S₅S-glycopyrronium bromide), Oxitropium bromide, Pirenzepine, telenzepine,

Tiotropium bromide, 3 (R)-(2-hydroxy-2,2-dithien-2-ylacetoxy)- 1 -(3 -phenoxypropyl)- 1 - azoniabicyclo[2.2.2]octane bromide, 3(R)-l-phenethyl-3-(9H-xanthene-9-carbonyloxy)-l- azoniabicyclo[2.2.2]octane bromide or (3R)-3-[(2S)-2-cyclopentyl-2-hydroxy-2-thien-2- ylacetoxy]-l-(2-phenoxyethyl)-l-azoniabicyclo[2.2.2]actane bromide; a p38 inhibitor; a PDE inhibitor; a PPARγ agonist; a protease inhibitor; a Statin; a thromboxane antagonist; a vasodilator; or, an ENAC blocker (Epithelial Sodium-channel blocker).

In one particular aspect the present invention provides a pharmaceutical product wherein the first and second active ingredients are in forms suitable for oral administration (for example for delivery to the lungs and/or airways). The pharmaceutical product of the present invention comprises a first active ingredient and a second active ingredient, and it may comprise a third active ingredient. The third active ingredient can be chosen from the list of second active ingredients but would normally have a different mechanism of action. So, for example, the second active ingredient might be a muscarinic antagonist and the third active ingredient might be: a non-steroidal glucocorticosteroid receptor agonist, corticosteroid, a CCRl antagonist or a PDE4 inhibitor.

A suitable salt of N-[2-(Diethylamino)ethyl]-N-(2-{[2-(4-hydroxy-2-oxo-2,3-dihydro-l,3- benzothiazol-7-yl)ethyl]amino}ethyl)-3-[2-(3-chlorophenyl)ethoxy]propanamide is, for example, a hydrochloride, hydrobromide (such as dihydrobromide), trifluoroacetate, sulphate, phosphate, acetate, fumarate, maleate, tartrate, lactate, citrate, pyruvate, succinate, oxalate, methanesulphonate, j>-toluenesulphonate, bisulphate, benzenesulphonate, ethanesulphonate, malonate, xinafoate, ascorbate, oleate, nicotinate, saccharinate, adipate, formate, glycolate, L-lactate, D-lactate, aspartate, malate, L-tartrate, D-tartrate, stearate, 2-furoate, 3-furoate, napadisylate (naphthalene- 1, 5 -disulfonate or naphthalene- 1 -(sulfonic acid)-5-sulfonate), edisylate (ethane- 1,2-disulfonate or ethane-1- (sulfonic acid)-2-sulfonate), isethionate (2-hydroxyethylsulfonate), 2-mesitylenesulphonate and 2-naphthalenesulphonate.

The first and second active ingredients can be administered simultaneously (either in a single pharmaceutical preparation {that is, the active ingredients are in admixture} or via separate preparations), or sequentially or separately via separate pharmaceutical preparations.

A non-steroidal glucocorticoid receptor (GR) agonist is, for example, a compound disclosed in WO 2006/046916.

An antioxidant is, for example, Allopurinol, Erdosteine, Mannitol, N-acetyl cysteine choline ester, N-acetyl cysteine ethyl ester, N-Acetylcysteine, N-Acetylcysteine amide or Niacin. A CCRl antagonist is, for example, a compound disclosed in WO2001/062728 or WO2001/098273, or a pharmaceutically acceptable salt thereof (such as a hydrochloride, trifluoroacetate, sulphate, (hemi)fumarate, benzoate, furoate or succinate salt); BX471 ((2R)-l-[[2-[(aminocarbonyl)amino]-4-chlorophenoxy]acetyl]-4-[(4-fluorophenyl)methyl]- s 2-methylpiperazine monohydrochloride) or CCX634.

Also, a CCRl antagonist is, for example, a compound disclosed in WO2001/062728 or WO2001/098273 [such as N-(2{(2S)-3[{(3R)-l-[(4-chlorophenyl)methyl]-3- pyrrolidinyl } amino] -2-hy droxypropoxy } -4-fluoropheny l)acetamide, N-(2 { (2 S)-3 [ { (3 S)- 1 - io [(4-chlorophenyl)methyl]-3-pyrrolidinyl}amino]-2-hydroxypropoxy}-4- fluorophenyl)acetamide, N-(2- { (2S)-3 - [ 1 - { (4-chlorobenzoyl)-4-piperidinyl} amino] -2- hy droxypropoxy }-4-hydroxyphenyl)acetamide, (2-{[(2S)-3-{[(2R,5S)-l-(4-chlorobenzyl)- 2,5-dimethylpiperidin-4-yl]amino}-2-hydroxy-2-methylpropyl]oxy}-4-fluorophenyl)acetic acid, (2- { [(2S)-3- { [(3 S,4R)- 1 -(4-chlorobenzyl)-3-methylpiperidin-4-yl]amino} -2-hydroxy-

I₅ 2-methylpropyl]oxy}-4-fluorophenyl)acetic acid, (2-{[(2S)-3-{[(3R,4R)-l-(4- chlorobenzyl)-3-methylpiperidin-4-yl]amino}-2-hydroxy-2-methylpropyl]oxy}-4- fiuorophenyl)acetic acid, (2- { [(2S)-3- { [(2R,4S,5 S)- 1 -(4-chlorobenzyl)-2,5- dimethy lpiperidin-4-y 1] amino } -2-hy droxy-2-methy lpropyl] oxy } -4-fluoropheny Fjacetic acid, (2-{[(2S)-3-{[(2R,4R,5S)-l-(4-chlorobenzyl)-2,5-dimethylpiperidin-4-yl]amino}-2-

20 hydroxy-2-methylpropyl]oxy}-4-fluorophenyl)acetic acid, (2-{[(2S)-3-{[(2S,4R,5R)-l-(4- chlorobenzyl)-2,5-dimethylpiperidin-4-yl]amino}-2-hydroxy-2-methylpropyl]oxy}-4- fluorophenyl)acetic acid, (2-{[(2S)-3-{[(2S,4S,5R)-l-(4-chlorobenzyl)-2,5- dimethylpiperidin-4-yl]amino}-2-hydroxy-2-methylpropyl]oxy}-4-fluorophenyl)acetic acid, Methyl (2- { [(25)-3- { [1 -(4-chlorobenzyl)piperidin-4-yl]amino} -2-

2₅ hydroxypropy l]oxy } -4-fluoropheny l)propanoate, N-[2-({2S}-3-[(l- [4-chlorobenzy 1] -A- piperidinyl)amino] -2-hydroxypropoxy)-4-chlorophenyl acetamide, N- [2-( {2S } -3- [( 1 -[4- chlorobenzyl]-4-piperidinyl)amino]-2-hydroxy-2-methylpropoxy)-4-hydroxyphenyl] acetamide, N- [2-( {2S } -3 - [( 1 - [4-chlorobenzy 1] -4-piperidinyl)amino]-2-hydroxy-2- methylpropoxy)-4-fluorophenyl] acetamide, N-[5-chloro-[2-({2S}-3-[(l-[4-chlorobenzyl]- .

30 4-piperidinyl)amino]-2-hydroxy-2-methylpropoxy)-4-hydroxyphenyl] acetamide, N- [5- chloro- [2-( { 2 S } -3 - [( 1 - [4-chlorobenzy 1] -4-piperidinyl)amino] -2-hydroxy-2- methylpropoxy)-4-hydroxyρhenyl] propaneamide, (2-{[(25)-3-{[l-(4- chlorobenzyl)piperidin-4-y 1] amino } -2-hy droxy-2-methylpropy 1] oxy } -4- fluorophenyl)methanesulfonic acid, N-5-chloro-(2-{(2S)-3-[l-{(4-chlorobenzyl)-4- piperidinyl } amino] -2-hy droxypropoxy } -4-hydroxyphenyl)-N ' -cy clopropy 1-urea, N- (2- {(2S)-3-[l-{ (4-chlorobenzyl)-4-piperidinyl } amino] -2-hy droxypropoxy } -pheny I)-N' -ethyl- urea, (2S)-l-(2-ethylphenoxy)-3[(l-[4-chlorobenzyl]4-piperidinyl)amino]propan-2-ol, (2S)-l-[2-(-hydroxyethyl)phenoxy]-2-methyl-3[(l-[4-chlorobenzyl]-4- piperidinyl)amino]piOpan-2-ol, 2-({2S}-3-[(l-[4-chlorobenzyl]-4-piperidinyl)amino]-2- hydroxy-2-methylpropoxy)benzaldehyde, 2-({2S}-3-[(l- [4-chlorobenzyl] -4- piperidinyl)amino]-2-hydroxypropoxy)-N-cyclopropylbenzamide, Methyl 2-({2S}-3-[(l- [4-chlorobenzyl]-4-piperidinyl)amino]-2-hydroxypropoxy)-4-fluorobenzoate, N-(2- { [(2S)- 3-(5-chloro-lΗ,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}-4- hydroxyphenyl)acetamide, N-(2-{[(2S)-3-(5-chloro-lΗ-spiro[l,3-benzodioxole-2,4'- piperidin]-r-yl)-2-hydroxypropyl]oxy}-4-hydroxyphenyl)acetamide, 2-{[(2S)-3-(5-chloro- 1 'H,3H-spiro [ 1 -benzofuran-2,4'-piperidin] - 1 '-yl)-2-hydroxypropyl] oxy } -4-hydroxy-N- methylbenzamide, 2-{[(2S)-3-(5-chloro-lΗ,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)- 2-hy droxypropyl]oxy}-4-hydroxybenzoic acid, N-(2-{[(2S)-3-(5-chloro-l'H,3H-spiro[2- benzofuran-l,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}-4-hydroxyphenyl)acetamide; 2-{[(2S)-3-(5-chloro-lΗ₅3H-spiro[2-benzofuran-l,4'-piperidin]-l'-yl)-2- hydroxypropyl]oxy}-4-hydroxy-N-methylbenzamide, N-(2-{[(2S)-3-(5-fluoro-l'H,3H- spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}-4- hydroxypheny l)acetamide, 2-{[(2S)-3-(5 -fluoro- 1 Η,3 H-spiro [ 1 -benzofuran-2,4'- piperidin] - 1 '-y l)-2-hy droxypropy 1] oxy } -4-hydroxy-N-methy lbenzamide, N- [2-( { (2 S)-3 - [(2R)-5-chloro-lΗ,3H-spiro[l-benzofuran-2,3'-pyrrolidin]-r-yl]-2-hydroxypropyl}oxy)-4- hydroxyphenyl]acetamide, N-(2-{[(2S)-3-(5-chloiO-lΗ,3H-spiro[l-benzofuran-2,4'- piperidin]-l'-yl)-2-hydroxypropyl]oxy}-4-hydroxyphenyl)urea, 4-fluoro-2-{[(2S)-3-(5- fluoiO-rH,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}benzoic acid, N-(2-{[(2S)-3-(5-chloro-lΗ,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2- hydroxypropyl]oxy}-4-fluorophenyl)urea, N-(2-{[(2S)-2-amino-3-(5-fluoro-l'H,3H- spiro[l-benzofuran-2,4'-piperidin]-r-yl)propyl]oxy}-4-hydroxyphenyl)acetamide, 2-[(2S)- 3-(5-chlorospiro[benzofuran-2(3H),4'-piperidin]-r-yl)-2-hydroxypropoxy]-benzaldehyde, (αS)-5-chloro-α-[[2-(2-hydroxyethyl)phenoxy]methyl]-Spiro[benzofuran-2(3H),4'- piperidine]-l'-ethanol, (αS)-5-chloro-α-[[2-(hydroxymethyl)phenoxy]methyl]- Spiro[benzofuran-2(3H),4'-piperidine]-r-ethanol, N-(2-{[(2S)-3-(5-chloro-lΗ,3H-spiro[l- benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}-5-chloro-4- hydroxyphenyl)acetamide, 2-Chloro-5-{[(2S)-3-(5-chloro-rH,3H-spiro[l-benzofuran-2,4'- piperidin]-r-yl)-2-hydroxypropyl]oxy}-(4-{acetylamino}phenoxy)acetic acid, 5-{[(2S)-3- (5-Chloro-l'H,3H-spiro[l -benzofuran-2,4'-piperidin]- 1 '-yl)-2-hydroxypropyl]oxy}-(4- {acetylamino}phenoxy)acetic acid, {2-Chloro-5-{[(25)-3-(5-chloro-rH,3/f-spiro[l- benzofuran-2,4'-piperidin]- l'-yl)-2-hydroxypropyl]oxy } -4-

[(methylamino)carbonyl]phenoxy } acetic acid, 2- {2-Chloro-5- { [(25)-3-(5-chloro- 1 'H,3H- spiro[l-benzofuran-2,4'-piperidin]-l'-yl)-2-hydroxypropyl]oxy}-4- [(methylamino)carbonyl]phenoxy}-2-methylpropanoic acid, (2-Chloro-5-{[(25)-3-(5- chloro- 1 'H,3H-spiro [ 1 -benzofuran-2,4'-piperidin]- 1 '-yl)-2-hydroxypropyl] oxy } -4- { [(3S)-3 - hydroxypyrrolidin-l-yl]carbonyl}phenoxy)acetic acid, 5-Chloro-2-{[(25)-3-(5-chloro- 1 'H,3H-spiro [1 -benzofuran-2,4'-piperidin]- 1 '-yl)-2-hydroxypropyl]oxy } -4- (cyanomethoxy)benzoic acid, 2- { [(2S)-3-(5-chloro- 1 Η,3Η-spiro[ 1 -benzofuran-2,4'- piperidin]-l'-yl)-2-hydroxypropyl]oxy}-5-chloro-4-(2,2-difluoroethoxy)benzoic, 5-Chloro-

hydr oxy propyl] oxy } -4-(3 ,3 ,3 -trifluoropropoxy)benzoic acid, N-(2- { 3 - [5-cliloro- 1 Η,3H- spiro[l-benzofuran-2,4'-piperidin]-r-yl]propoxy}phenyl)acetamide, Methyl 3-(2-{[(2S)-3- (5-chloro-lΗ3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}-4- fluorophenyl)propanoic acid, N-(2-{[(2S)-3-({spiro[indole-2-4'-piperidin]-3(lH)-one}-r- yl)-2-hydroxypropyl]oxy } -4-hydroxyphenyl)acetamide, or (2- { [(25)-3-(5-Chloro- 1 '//,3H- spiro [ 1 -benzofuran-2,4'-piperidin] - 1 '-yl)-2-hydroxypropyl]oxy } -4- fluorophenyl)methanesulfonic acid, or a pharmaceutically acceptable salt thereof (for example as described above; (such as a hydrochloride, trifluoroacetate, sulphate, (hemi)fumarate, benzoate, furoate or succinate salt))]; BX471 ((2R)-l-[[2-

[(aminocarbonyl)amino]-4-chlorophenoxy]acetyl]-4-[(4-fluorophenyl)methyl]-2- methylpiperazine monohydrochloride); or CCX634.

Also, a CCRl antagonist is, for example, N-{2-[((25)-3-{[l-(4-chlorobenzyl)piperidin-4- yl]amino}-2-hydroxy-2-methylpropyl)oxy]-4-hydroxyphenyl}acetamide (see WO 2003/051839), or, 2-{2-Chloro-5-{[(2S)-3-(5-chloro-l'H,3H-spiro[l-benzofuran-2,4'- piperidin]- 1 '-yl)-2-hydroxypropyl]oxy } -4-[(methylamino)carbonyl]phenoxy } -2- methylpropanoic acid (see PCT publication no. WO 2008/010765), or a pharmaceutically acceptable salt thereof (for example a hydrochloride, sulphate, (hemi)fumarate, benzoate, furoate or succinate salt).

A chemokine antagonist (other than a CCRl antagonist), for example, 656933 (N-(2- bromophenyl)-N'-(4-cyano-lH-l,2,3-benzotriazol-7-yl)urea), 766994 (4-({[({[(2R)-4-(3,4- dichlorobenzyl)morpholin-2-yl]methyl}amino)carbonyl]-amino}methyl)benzamide), CCX-282, CCX-915, Cyanovirin N, E-921, INCB-003284, INCB-9471, Maraviroc, MLN- 3701, MLN-3897, T-487 (N-{l-[3-(4-ethoxyphenyl)-4-oxo-3,4-dihydropyrido[2,3- d]pyrimidin-2-yl]ethyl}-N-(pyridin-3-ylmethyl)-2-[4-(trifluoromethoxy)phenyl]acetamide) or Vicriviroc.

A corticosteroid is, for example, Alclometasone dipropionate, Amelometasone, Beclomethasone dipropionate, Budesonide, Butixocort propionate, Ciclesonide, Clobetasol propionate, Desisobutyrylciclesonide, Etiprednol dicloacetate, Fluocinolone acetonide, Fluticasone Furoate, Fluticasone propionate, Loteprednol etabonate (topical) or Mometasone furoate.

A CRTh2 antagonist is, for example, a compound from WO 2004/106302 or WO 2005/018529.

A DPI antagonist is, for example, L888839 or MK.0525.

An histone deacetylase inducer is, for example, ADC4022, Aminophylline, a Methylxanthine or Theophylline.

An IKK2 inhibitor is, for example, 2-{[2-(2-Methylamino-pyrimidin-4-yl)-lH-indole-5- carbonyl]-amino}-3-(phenyl-pyridin-2-yl-amino)-propionic acid.

A COX inhibitor is, for example, Celecoxib, Diclofenac sodium, Etodolac, Ibuprofen, Indomethacin, Meloxicam, Nimesulide, OC 1768, OC2125, OC2184, OC499, OCD9101, Parecoxib sodium, Piceatannol, Piroxicam, Rofecoxib or Valdecoxib. A lipoxygenase inhibitor is, for example, Ajulemic acid, Darbufelone, Darbufelone mesilate, Dexibuprofen lysine (monohydrate), Etalocib sodium, Licofelone, Linazolast, Lonapalene, Masoprocol, MN-OOl , Tepoxalin, UCB-35440, Veliflapon, ZD-2138, ZD- 4007 or Zileuton ((±)-l-(l-Benzo[b]thien-2-ylethyl)-l-hydroxyurea)

A leukotriene receptor antagonist is, for example, Ablukast, Iralukast (CGP 45715A), Montelukast, Montelukast sodium, Ontazolast, Pranlukast, Pranlukast hydrate (mono Na salt), Verlukast (MK-679) or Zafirlukast.

An MPO Inhibitor is, for example, a Hydroxamic acid derivative (N-(4-chloro-2-methyl- phenyl)-4-phenyl-4-[[(4-propan-2-ylphenyl)sulfonylamino]methyl]piperidine-l- carboxamide), Piceatannol or Resveratrol.

A muscarinic antagonist is Aclidinium bromide, Glycopyrrolate (such as R₅R-, R₅S-, S₅R-, or S,S-glycopyrronium bromide), Oxitropium bromide, Pirenzepine, telenzepine, Tiotropium bromide, 3 (R)-(2-hydroxy-2,2-dithien-2-ylacetoxy)- 1 -(3 -phenoxypropyl)- 1 - azoniabicyclo[2.2.2]octane bromide (see WO 01/04118), 3(R)-l-phenethyl-3-(9H- xanthene-9-carbonyloxy)-l-azoniabicyclo[2.2.2]octane bromide or (3R)-3-[(2S)-2- cyclopentyl-2-hydroxy-2-thien-2-ylacetoxy]- 1 -(2-phenoxyethyl)- 1 - azoniabicyclo[2.2.2]actane bromide (see WO 01/04118). In one aspect of the invention a muscarinic antagonist is Aclidinium bromide, Glycopyrrolate (such as R₅R-, R,S-, S₅R-, or S,S-glycopyrronium bromide), Oxitropium bromide, Pirenzepine, telenzepine or Tiotropium bromide.

A p38 Inhibitor is, for example, a compound from WO 2005/042502, 681323, 856553, AMG548 (2-[[(2S)-2-amino-3-phenylpropyl]amino]-3-methyl-5-(2-naphthalenyl)-6-(4- pyridinyl)-4(3H)-pyrimidinone), Array-797, Doramapimod, KC-706, PH 797804, Rl 503, SC-80036, SCIO469, 6-chloro-5-[[(2,S,5i?)-4-[(4-fluorophenyl)methyl]-2,5-domethyl-l- piperazinylJcarbonylJ-^Λζl-trimethyl-α-oxo-lH-indole-S-acetamide, VX702 or VX745 (5-(2,6-dichlorophenyl)-2-(phenylthio)-6H-pyrimido[l,6-b]pyridazin-6-one). A PDE Inhibitor: such as a PDE4 inhibitor, for example, 256066, Arofylline (3-(4- chlorophenyl)-3,7-dihydro-l-propyl-lH-Purine-2,6-dione), AWD 12-281 (N-(3,5-dichloro- 4-pyridinyl)-l-[(4-fluorophenyl)methyl]-5-hydroxy-α-oxo-lH-indole-3-acetamide), BAYl 9-8004 (Bayer), CDC-801 (Calgene), Celgene compound ((βR)-β-(3,4- dimethoxyphenyl)- 1 ,3-dihydro- 1 -oxo-2H-isoindole-2-propanamide), Cilomilast (cis-4- cyano-4-[3-(cyclopentyloxy)-4-methoxyphenyl]-cyclohexanecarboxylic acid), a compound in WO2006098353 from Kyowa Hakko Kogyo Co. Ltd. Japan, 2-(3,5-dichloro-4- pyridinyl)-l-(7-methoxyspiro[l,3-benzodioxole-2,r-cyclopentan]-4-yl)ethanone (CAS number 185406-34-2)), Compound from Pfizer (2-(3,4-difluorophenoxy)-5-fluoro-N-[cis- 4-[(2-hydroxy-5-methylbenzoyl)amino]cyclohexyl]-)-3-pyridinecarboxamide), Compound from Pfizer (2-(3,4-difluoiOphenoxy)-5-fluoro-N-[cis-4-[[2-hydiOxy-5- (hydroxymemy^benzoyljaminojcyclohexyl^-pyridinecarboxamide,), CT2820, GPD- 1116, Ibudilast, IC 485, KF 31334, KW-4490 (Kyowa Hakko Kogyo), Lirimilast ([2-(2,4- dichlorobenzoyl)-6-[(methylsulfonyl)oxy]-3-benzofuranyl])-urea), Merck Compound (N- cyclopropyl-l,4-dihydro-4-oxo-l-[3-(3-pyridinylethynyl)phenyl]-)-l,8-naphthyridine-3- carboxamide), Oglemilast (N-(3,5-dichloro-4-pyridinyl)-4-(difluoromethoxy)-8- [(methylsulfonyl)amino])-l-dibenzofurancai-boxamide), ONO6126, ORG 20241 (4-(3,4- dimethoxyphenyl)-N-hydroxy-)-2-thiazolecarboximidamide), PD 189659/PD 168787 (Parke-Davis), Pentoxifylline (3,7-dihydro-3,7-dimemyl-l-(5-oxohexyl)-)-lH-purine-2,6- dione), Pfizer compound (5-fluoro-N-[4-[(2-hydroxy-4-methyl- benzoyl)amino]cyclohexyl]-2-(thian-4-yloxy)pyridine-3-carboxamide), Pfizer UK 500,001 , Piclamilast (3-(cyclopentyloxy)-N-(3,5-dichloro-4-pyridinyl)-4-methoxy- benzamide), PLX-369 (WO 2006026754), Roflumilast (3-(cyclopropylmethoxy)-N-(3,5- dichloro-4-ρyridinyl)-4-(difluoromethoxy)benzamide), SCH 351591 (N-(3,5-dichloro-l- oxido-4-pyridinyl)-8-methoxy-2-(trifluoromethyl)-5-quinolinecarboxamide), SeICID(TM) CC-10004 (Calgene), T-440 (Tanabe), Tetomilast (6-[2-(3,4-diethoxyphenyl)-4-thiazolyl]- 2-pyridinecarboxylic acid), Tofimilast (9-cyclopentyl-7-ethyl-6,9-dihydro-3-(2-thienyl)- 5H-pyrazolo[3,4-c]-l,2,4-triazolo[4,3-a]pyridine), TPI 1100, UCB 101333-3 (N,2- dicyclopropyl-6-(hexahydro- 1 H-azepin- 1 -yl)-5-methyl-4-pyrimidinamine), V-Il 294 A (Napp), VM554/VM565 (Vernalis), or Zardaverine (6-[4-(difluoromethoxy)-3- methoxyphenyl]-3(2H)-pyridazinone); or a PDE5 Inhibitor, for example, Gamma- glutamyl[s-(2-iodobenzyl)cysteinyl]glycine, Tadalafil, Vardenafil, sildenafil, 4-phenyl- methy lamino-6-chloro-2-( 1 -imidazolyl)-quinazoline, 4-phenyl-methylamino-6-chloro-2- (3-pyridyl)-quinazoline, l,3-dimethyl-6-(2-piOpoxy-5-methanesulphonylamidophenyl)- 1 ,5-dihydropyrazolo[3,4-d]pyrimidin-4-one or 1 -cyclopentyl-3-ethyl-6-(3-ethoxy-4- pyridyl)-pyrazolo [3 ,4-d]pyrimidin-4-one.

A PPARγ agonist is, for example, Pioglitazone, Pioglitazone hydrochloride, Rosiglitazone Maleate, Rosiglitazone Maleate ((-)-enantiomer, free base), Rosiglitazone maleate/Metformin hydrochloride or Tesaglitizar.

A Protease Inhibitor is, for example, Alphal -antitrypsin proteinase Inhibitor, EPI-HNE4, UT-77, ZD-0892 or a compound from WO 2006/004532, WO 2005/026123, WO 2002/0744767 or WO 22002/074751; or a TACE Inhibitor (for example DPC-333, Sch- 709156 or Doxycycline).

A Statin is, for example, Atorvastatin, Lovastatin, Pravastatin, Rosuvastatin or Simvastatin.

A Thromboxane Antagonist is, for example, Ramatroban or Seratrodast.

A Vasodilator is, for example, A-306552, Ambrisentan, Avosentan, BMS-248360, BMS- 346567, BMS-465149, BMS-509701, Bosentan, BSF-302146 (Ambrisentan), Calcitonin Gene-related Peptide, Daglutril, Darusentan, Fandosentan potassium, Fasudil, Iloprost, KC-12615 (Daglutril) , KC-12792 2AB (Daglutril) , Liposomal treprostinil, PS-433540, Sitaxsentan sodium, Sodium Ferulate, TBC-11241 (Sitaxsentan), TBC-3214 (N-(2-acetyl- 4,6-dimethylphenyl)-3-[[(4-chloro-3-methyl-5-isoxazolyl)amino]sulfonyl]-2- thiophenecarboxamide), TBC-3711, Trapidil, Treprostinil diethanolamine or Treprostinil sodium.

An ENAC (Epithelial Sodium-channel blocker) is, for example, Amiloride, Benzamil, Triamterene, 552-02, PSA14984, PSA25569, PSA23682 or AER002.

All the above active ingredients may be in the form of a solvate, for example, a hydrate. In one particular aspect the present invention provides a pharmaceutical product comprising the first and second active ingredients in admixture. Alternatively, the pharmaceutical product may, for example, be a kit comprising a preparation of the first active ingredient and a preparation of the second active ingredient and, optionally, instructions for the simultaneous, sequential or separate administration of the preparations to a patient in need thereof.

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is iV-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2,3-dihydro- 1 ,3-benzothiazol-7-yl)ethyl]amino}ethyi)-3-[2-(3- chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient selected from: a non-steroidal Glucocorticoid Receptor (GR Receptor) Agonist; a CCRl antagonist; a chemokine antagonist (not CCRl); a corticosteroid; an IKK2 inhibitor; a muscarinic antagonist which is Aclidinium bromide, Glycopyrrolate (such as R₅R-, R₅S-,

S₅R-, or S,S-glycopyrronium bromide), Oxitropium bromide, Pirenzepine, telenzepine, Tiotropium bromide, 3 (R)-(2-hydroxy-2,2-dithien-2-ylacetoxy)- 1 -(3 -phenoxypropyl)- 1 - azoniabicyclo [2.2.2]octane bromide, 3 (R)- 1 -phenethyl-3 -(9H-xanthene-9-carbonyloxy)- 1 - azoniabicyclo[2.2.2]octane bromide or (3R)-3-[(2S)-2-cyclopentyl-2-hydroxy-2-thien-2- ylacetoxy]-l-(2-phenoxyethyl)-l-azoniabicyclo[2.2.2]actane bromide; a p38 inhibitor; or, a PDE inhibitor.

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl]amino } ethy l)-3 - [2-(3 - chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient which is a non-steroidal Glucocorticoid Receptor (GR) Agonist for example, a compound disclosed in WO 2006/046916. In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is 7V-[2-(Diethylamino)ethyi]-N-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl]amino } ethyl)-3 - [2-(3 - chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient which is a CCRl antagonist, for example, a compound disclosed in WO2001/062728 or WO2001/098273, or a pharmaceutically acceptable salt thereof (such as a hydrochloride, trifluoroacetate, sulphate, (hemi)fumarate, benzoate, furoate or succinate salt); BX471 ((2R)-l-[[2-[(aminocarbonyl)amino]-4-chlorophenoxy]acetyl]-4-[(4-fluorophenyl)methyl]- 2-methylpiperazine monohydrochloride) or CCX634.

In yet another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is iV-[2-(Diethylamino)ethyl]-./V-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl]amino } ethyl)-3 - [2-(3 - chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient which is a CCRl antagonist, for example, a compound disclosed in WO2001/062728 or WO2001/098273 [such as N-(2{(2S)-3[{(3R)-l-[(4-chlorophenyl)methyl]-3- pyrrolidinyl} amino] -2-hydroxypropoxy } -4-fiuorophenyl)acetamide, N-(2 { (2S)-3 [ { (3 S)- 1 - [(4-chlorophenyl)methyl]-3-pyrrolidinyl}amino]-2-hydroxypropoxy}-4- fluorophenyl)acetamide, N-(2- { (2S)-3 - [ 1 - { (4-chlorobenzoyl)-4-piperidinyl} amino]-2- hydroxypropoxy } -4-hydroxyphenyl)acetamide, (2- { [(2S)-3 - { [(2R,5 S)- 1 -(4-chlorobenzyl)- 2,5-dimethylpiperidin-4-yl]amino}-2-hydroxy-2-methylpropyl]oxy}-4-fluorophenyl)acetic acid, (2- { [(2S)-3- { [(3 S.4R)- 1 -(4-chlorobenzyl)-3-methylpiperidin-4-yl] amino} -2-hydroxy- 2-methylpropyl]oxy } -4-fluorophenyl)acetic acid, (2- { [(2S)-3- { [(3R,4R)- 1 -(4- chlorobenzyl)-3-methylpiperidin-4-yl]amino}-2-hydroxy-2-methylpropyl]oxy}-4- fluorophenyl)acetic acid, (2-{[(2S)-3-{[(2R,4S,5S)-l-(4-chlorobenzyl)-2,5- dimethylpiperidin-4-yl]amino}-2-hydroxy-2-methylpropyl]oxy}-4-fluorophenyl)acetic acid, (2- { [(2S)-3- { [(2R,4R,5S)- 1 -(4-chlorobenzyl)-2,5-dimethylpiperidin-4-yl]amino} -2- hydroxy-2-methylpropyl]oxy}-4-fluorophenyl)acetic acid, (2-{ [(2S)-3-{ [(2S,4R,5R)- 1 -(4- chlorobenzyl)-2,5-dimethylpiperidin-4-yl]amino}-2-hydroxy-2-methylpropyl]oxy}-4- fluorophenyl)acetic acid, (2-{[(2S)-3-{[(2S,4S,5R)-l-(4-chlorobenzyl)-2,5- dimethylpiperidin-4-yl]amino}-2-hydroxy-2-methylpropyl]oxy}-4-fluorophenyl)acetic acid, Methyl (2- { [(25)-3 - { [ 1 -(4-chlorobenzyl)piperidin-4-y 1] amino } -2- hydroxypropyl]oxy}-4-fluoroplienyl)propanoate, N-[2-({2S}-3-[(l-[4-chlorobenzyl]-4- piperidinyl)amino]-2-liydroxypropoxy)-4-chloiOphenyl acetamide, N-[2-({2S}-3-[(l-[4- chlorobenzyl]-4-piperidinyl)amino]-2-hydroxy-2-methylpropoxy)-4-hydroxyphenyl]

5 acetamide, N- [2-( {2S } -3 - [( 1 - [4-chlorobenzyl] -4-piperidinyl)amino]-2-hydroxy-2- methylpropoxy)-4-fluorophenyl] acetamide, N- [5 -chloro- [2-({2S}-3-[(l- [4-chlorobenzyl] - 4-piperidinyl)amino]-2-hydroxy-2-methylpropoxy)-4-hydiOxyphenyl] acetamide, N- [5- chloro- [2-( {2S } -3 -[( 1 - [4-chlorobenzyl] -4-piperidinyl)amino] -2-hy droxy-2- methylpropoxy)-4-hydroxyphenyl] propaneamide, (2- { [(2<S)-3 - { [ 1 -(4- i o chlorobenzyl)piperidin-4-y 1] amino } -2-hydroxy-2-methy lpropy 1] oxy } -4- fluorophenyl)methanesulfonic acid, N-5-chloro-(2- { (2S)-3 - [ 1 - { (4-chlorobenzyl)-4- piperidinyl}amino]-2-hydroxypropoxy}-4-hydroxyphenyl)-N'-cyclopropyl-urea, N-(2- {(2S)-3-[l-{ (4-chlorobenzyl)-4-piperidinyl } amino] -2-hydroxypropoxy } -phenyl)-N ' -ethyl- urea, (2S)-I -(2-ethylphenoxy)-3 [( 1 - [4-chlorobenzyl]4-piperidinyl)amino]propan-2-ol, is (2S)-I -[2-(-hydroxyethyl)phenoxy]-2-methyl-3 [(I -[4-chlorobenzyl] -4- piperidinyl)amino]propan-2-ol, 2-( {2S } -3 - [( 1 -[4-chlorobenzyl] -4-piperidinyl)amino] -2- hydroxy-2-methylpropoxy)benzaldehyde, 2-({2S}-3-[(l-[4-chlorobenzyl]-4- piperidinyl)amino]-2-hydroxypropoxy)-N-cyclopropylbenzamide, Methyl 2-({2S}-3-[(l- [4-chlorobenzyl]-4-piperidinyl)amino]-2-hydroxypropoxy)-4-fluorobenzoate, N-(2- { [(2S)-

20 3-(5-chloro-rH,3H-spiro[l-benzofuran-2,4'-piperidin]-l'-yl)-2-hydroxypropyl]oxy}-4- hydroxyphenyl)acetamide, N-(2-{ [(2S)-3-(5-chloro- 1 'H-spiro[l ,3-benzodioxole-2,4'- piperidin] - 1 '-yl)-2-hy droxypropy 1] oxy } -4-hydroxyphenyl)acetamide, 2-{[(2S)-3-(5 -chloro- lΗ,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}-4-hydroxy-N- methylbenzamide, 2-{[(2S)-3-(5-chloro-lΗ,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-

2₅ 2-hydroxypropyl]oxy}-4-hydroxybenzoic acid, N-(2-{[(2S)-3-(5-chloro-l'H,3H-spiro[2- benzofuran- 1 ,4'-piperidin]- 1 '-yl)-2-hydroxypropyl]oxy } -4-hydroxyphenyl)acetamide; 2-{ [(2S)-3-(5-chloro-lΗ,3H-spiro[2-benzofuran-l ,4'-piperidin]- 1 '-yl)-2- hy droxypropy 1] oxy } -4-hy droxy-N-methylbenzamide, N-(2- { [(2 S)-3 -(5 -fluoro- 1 Η,3 H- spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}-4-

30 hydroxyphenyl)acetamide, 2-{[(2S)-3-(5-fluoro-lΗ,3H-spiro[l-benzoruran-2,4'- piperidin]-r-yl)-2-hydroxypropyl]oxy}-4-hydroxy-N-methylbenzamide, N-[2-({(2S)-3- [(2R)-5-chloro-rH,3H-spiro[l-benzofuran-2,3'-pyrrolidin]-r-yl]-2-hydroxypropyl}oxy)-4- hydroxyphenyl]acetamide, N-(2-{[(2S)-3-(5-chloro-lΗ,3H-spiro[l-benzofuran-2,4'- piperidin]-r-yl)-2-hydiOxypiOpyl]oxy}-4-hydroxyphenyl)urea, 4-fluoro-2-{[(2S)-3-(5- fluoro-lΗ,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}benzoic acid, N-(2-{[(2S)-3-(5-chloro-l'H,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2- hydroxypropyljoxy } -4-fluorophenyl)urea, N-(2- { [(2S)-2-amino-3-(5-fluoro- 1 Η,3H- spiro[l-benzofuran-2,4'-piperidin]-l'-yl)propyl]oxy}-4-hydroxyphenyl)acetamide, 2-[(2S)- 3-(5-chlorospiro[benzofui"an-2(3H),4'-piperidin]-l'-yl)-2-hydroxypropoxy]-benzaldehyde, (αS)-5-chloiO-α-[[2-(2-hydroxyethyl)phenoxy]methyl]-Spiro[benzofuran-2(3H),4'- piperidine]-l'-ethanol, (αS)-5-chloro-α-[[2-(hydroxymethyl)phenoxy]methyl]- Sρiro[benzofuran-2(3H),4'-piperidine]-r-ethanol, N-(2-{[(2S)-3-(5-chloiO-rH,3H-spiro[l- benzofuran-2,4'-piperidin]- 1 '-yl)-2-hydroxypropyl]oxy } -5-chloro-4- hydroxyphenyl)acetamide, 2-Chloro-5- { [(2S)-3-(5-chloro- 1 'H,3H-spiro[l -benzofuran-2,4¹- piperidin]- 1 '-yl)-2-hydroxypropyl]oxy}-(4- {acetylamino}phenoxy)acetic acid, 5-{ [(25)-3- (5-Chloro-r/f,3H-spiro[l-benzofuran-2,4'-piperidm]-r-yl)-2-hydroxypiOpyl]oxy}-(4- {acetylamino}phenoxy)acetic acid, ^-Chloro-S-l^^-S-^-chloro-rH^H-spirofl- benzofuran-2,4'-piperidin]- 1 '-yl)-2 -hydroxypropyljoxy } -4-

[(methylamino)carbonyl]phenoxy}acetic acid, 2-{2-Chloro-5-{[(2iS)-3-(5-chloro-rH,3H- spiro[l-benzofuran-2,4'-piperidin]-l'-yl)-2-hydroxypropyl]oxy}-4- [(methylamino)carbonyl]phenoxy}-2-methylpropanoic acid, (2-Chloro-5-{ [(25)-3-(5- chloro-rH,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}-4-{[(3<S)-3- hydroxypyrrolidin-l-yl]carbonyl}phenoxy)acetic acid, 5-Chloro-2-{[(25)-3-(5-chloro- rH,3H-spiro[l-benzoruran-2,4'-piperidin]-l'-yl)-2-hydroxypropyl]oxy}-4- (cyanomethoxy)benzoic acid, 2-{[(2S)-3-(5-chloro-l'Η,3Η-spiro[l-benzofuran-2,4'- piperidin]- 1 '-yl)-2-hydroxypropyl]oxy } -5-chloro-4-(2,2-difluoroethoxy)benzoic, 5-Chloro- 2-{[(25)-3-(5-chloro-rH,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2- hydroxypropyl]oxy } -4-(3 ,3 ,3 -trifluoropropoxy)benzoic acid, N-(2- { 3 - [5-chloro- 1 Η,3Η- spiro[l-benzofuran-2,4'-piperidin]-r-yl]propoxy}phenyl)acetamide, Methyl 3-(2-{[(2S)-3- (5-chloro- 1 'H3H-spiro[l -benzofuran-2,4'-piperidin]- 1 '-yl)-2-hydroxypropyl]oxy}-4- fluorophenyl)propanoic acid, N-(2- { [(2S)-3 -( { spiro[indole-2-4'-piperidin]-3 ( 1 Η)-one} - 1 '- yl)-2-hydroxypropyl]oxy } -4-hydroxyphenyl)acetamide, or (2- { [(25)-3-(5-Chloro- 1 'H,3H- spiro [ 1 -benzofuran-2,4'-piperidin] - 1 '-yl)-2-hydroxypropyl]oxy } -4- fluorophenyl)methanesulfonic acid, or a pharmaceutically acceptable salt thereof (for example as described above; (such as a hydrochloride, trifluoroacetate, sulphate, (hemi)fumarate, benzoate, furoate or succinate salt))]; BX471 ((2R)-l-[[2- [(aminocarbonyl)amino] -4-chlorophenoxy] acetyl] -4- [(4-fluoropheny l)methyl] -2- methylpiperazine monohydrochloride); or CCX634.

5

In another aspect a CCRl antagonist is N-{2-[((2iS)-3-{[l-(4-chlorobenzyl)piperidin-4- yl]amino}-2-hydroxy-2-methylpropyl)oxy]-4-hydroxyphenyl}acetamide, or, 2-{2-Chloro- 5-{[(2S)-3-(5-chloro-lΗ,3H-spiiO[l-benzofuran-2,4'-piperidin]-r-yl)-2- hydroxypropyl]oxy}-4-[(methylamino)carbonyl]phenoxy}-2-methylpropanoic acid,

IQ or a pharmaceutically acceptable salt thereof (for example a hydrochloride, sulphate, (hemi)fumarate, benzoate, furoate or succinate salt). For example N-{2-[((25)-3-{[l-(4- chlorobenzyl)piperidin-4-yl]amino}-2-hydroxy-2-methylpropyl)oxy]-4- hydroxyphenyl}acetamide as a benzoate salt, or, 2-{2-Chloro-5-{[(2S)-3-(5-chloro- lΗ,3H-spiro[l-benzofuran-2,4'-piperidin]-r-yl)-2-hydroxypropyl]oxy}-4-

I₅ [(methylamino)carbonyl]phenoxy}-2-methylpropanoic acid as the free acid.

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl] amino } ethyl)-3- [2-(3 -

2Q chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient which is a chemokine antagonist (not CCRl), for example, 656933 (Ν-(2-bromophenyl)-Ν'-(4- cyano-lH-1 ,2,3-benzotriazol-7-yl)urea), 766994 (4-({ [({ [(2R)-4-(3,4- dichlorobenzyl)moφholin-2-yl]methyl}amino)carbonyl]-amino}methyl)benzamide), CCX-282, CCX-915, Cyanovirin N, E-921, INCB-003284, INCB-9471, Maraviroc, MLN-

2s 3701, MLN-3897, T-487 (N-{l-[3-(4-ethoxyphenyl)-4-oxo-3,4-dihydropyrido[2,3- d]pyrimidin-2-yl]ethyl}-N-(pyridin-3-ylmethyl)-2-[4-(trifluoromethoxy)phenyl]acetamide) or Vicriviroc.

In another aspect the present invention provides a pharmaceutical product comprising, in 30 combination, a first active ingredient which is iV-[2-(Diethylamino)ethyl]-N-(2-{ [2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3-benzothiazol-7-yl)ethyl]amino } ethy l)-3 -[2-(3 - chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is a corticosteroid, for example, Alclometasone dipropionate, Amelometasone, Beclomethasone dipropionate, Budesonide, Butixocort propionate, Ciclesonide, Clobetasol propionate, Desisobutyrylciclesonide, Etiprednol dicloacetate, Fluocinolone acetonide, Fluticasone Furoate, Fluticasone propionate, Loteprednol etabonate (topical) or Mometasone furoate.

In one embodiment of the present invention the corticosteroid is selected from budesonide, fluticasone propionate, fluticasone fruoate mometasone furoate, beclomethasone dipropionate or butixocort propionate ester.

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is iV-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl]amino } ethyl)-3 - [2-(3- chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is a corticosteroid, for example, Budesonide, Fluticasone Furoate or Fluticasone propionate.

In one embodiment of the present invention the corticosteroid is budesonide. Budesonide and its preparation is described, for example, in Arzneimittel-Forschung (1979), 29 (11), 1687-1690, DE 2,323,215 and US 3,929,768. Presently available formulations of budesonide are marketed under the tradename 'Entocort ®\

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-N-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl]amino } ethyl)-3 - [2-(3- chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is an IKK2 inhibitor, for example, 2-{[2-(2-Methylamino-pyrimidin-4-yl)-lH-indole-5- carbonyl]-amino}-3-(phenyl-pyridin-2-yl-amino)-propionic acid.

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-N-(2-{[2-(4- hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol-7-yl)ethyl]amino}ethyl)-3-[2-(3- chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is a muscarinic antagonist, for example, Aclidinium bromide, Glycopyrrolate (such as R₃R-, R₅S-, S₅R-, or S,S-glycopyrronium bromide), Oxitropium bromide, Pirenzepine, telenzepine, Tiotropium bromide, 3(R)-(2-hydroxy-2,2-dithien-2-ylacetoxy)-l-(3- phenoxypropyl)-l-azoniabicyclo[2.2.2]octane bromide (see WO 01/04118), or 3(R)-I- phenethyl-3-(9H-xanthene-9-carbonyloxy)-l-azoniabicyclo[2.2.2]octane bromide or (3R)- 3-[(2S)-2-cyclopentyl-2-hydroxy-2-thien-2-ylacetoxy]-l-(2-phenoxyethyl)-l- azoniabicyclo[2.2.2]actane bromide (see WO 01/04118). In one aspect of the invention a muscarinic antagonist is Aclidinium bromide, Glycopyrrolate (such as R₅R-, R₅S-, S₅R-, or S₅S-glycopyrronium bromide), Oxitropium bromide, Pirenzepine, telenzepine or Tiotropium bromide.

In yet another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-N-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl]amino } ethyl)-3 - [2-(3 - chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is a muscarinic antagonist, for example, Aclidinium bromide, Glycopyrrolate (such as R₃R-, R₃S-, S₅R-, or S,S-glycopyrronium bromide), Oxitropium bromide, Pirenzepine, telenzepine or Tiotropium bromide.

In one aspect of the invention the muscarinic receptor antagonist is a long acting muscarinic receptor antagonist, i.e. a muscarinic receptor antagonist with activity that persists for more than 12 hours. Examples of long acting muscarinic receptor antagonists include tiotropium bromide.

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2₃3-dihydro-l,3-benzothiazol-7-yl)ethyl]amino}ethyl)-3-[2-(3- chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is Tiotropium bromide.

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethy ljamino } ethyl)-3 - [2-(3 - chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is a p38 inhibitor, for example, a compound from WO 2005/042502, 681323, 856553, AMG548 (2- [[(2S)-2-amino-3-phenylpropyl]amino]-3-methyl-5-(2-naphthalenyl)-6-(4-pyridinyl)- 4(3H)-pyrimidinone), Array-797, Doramapimod, KC-706, PH 797804, Rl 503, SC-80036, SCIO469, 6-chloro-5-[[(25',5i?)-4-[(4-fluorophenyl)methyl]-2,5-dometliyl-l- piperazinyl]carbonyl]-N,iV,l-trimethyl-α-oxo-lH-indole-3-acetamide, VX702 or VX745 (5-(2,6-dichlorophenyl)-2-(phenylthio)-6H-pyrimido[l,6-b]pyridazin-6-one).

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-N-(2-{[2-(4- hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol-7-yl)ethyl]amino}ethyl)-3-[2-(3- chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is a PDE Inhibitor: such as a PDE4 inhibitor {for example, 256066, Arofylline (3-(4- chlorophenyl)-3,7-dihydro-l -propyl- lH-Purine-2,6-dione), AWD 12-281 (N-(3,5-dichloro- 4-pyridinyl)-l-[(4-fluorophenyl)methyl]-5-hydroxy-α-oxo-lH-indole-3-acetamide), BAYl 9-8004 (Bayer), CDC-801 (Calgene), Celgene compound ((βR)-β-(3,4- dimethoxyphenyl)-l,3-dihydro-l-oxo-2H-isoindole-2-propanamide), Cilomilast (cis-4- cyano-4-[3-(cyclopentyloxy)-4-methoxyphenyl]-cyclohexanecarboxylic acid), a compound in WO2006098353 from Kyowa Hakko Kogyo Co. Ltd. Japan, 2-(3,5-dichloro-4- pyridinyl)- 1 -(7-methoxyspiro [ 1 ,3-benzodioxole-2, 1 '-cyclopentan] -4-yl)ethanone (CAS number 185406-34-2)), Compound from Pfizer (2-(3,4-difluorophenoxy)-5-fluoro-N-[cis- 4-[(2-hydroxy-5-methylbenzoyl)amino]cyclohexyl]-)-3-pyridinecarboxamide), Compound from Pfizer (2-(3,4-difluorophenoxy)-5-fluoro-N-[cis-4-[[2-hydroxy-5- (hydroxymethy^benzoyljaminoJcyclohexylJ-S-pyridinecarboxamide,), CT2820, GPD- 1116, Ibudilast, IC 485, KF 31334, KW-4490 (Kyowa Hakko Kogyo), Lirimilast ([2-(2,4- dichlorobenzoyl)-6-[(methylsulfonyl)oxy]-3-benzofuranyl])-urea), Merck Compound (N- cyclopropyl- 1 ,4-dihydro-4-oxo- 1 - [3 -(3 -pyridinylethynyl)phenyl] -)- 1 ,8-naphthyridine-3 - carboxamide), Oglemilast (N-(3,5-dichloro-4-pyridinyl)-4-(difluoromethoxy)-8- [(methylsulfonyl)amino])-l-dibenzofurancarboxamide), ONO6126, ORG 20241 (4-(3,4- dimethoxyphenyl)-N-hydroxy-)-2-thiazolecarboximidamide), PD 189659/PD 168787 (Parke-Davis), Pentoxifylline (3,7-dihydro-3,7-dimethyl-l-(5-oxohexyl)-)-lH-purine-2,6- dione), Pfizer compound (5-fluoro-N-[4-[(2-hydroxy-4-methyl- benzoyl)amino] cyclohexyl] -2-(thian-4-y loxy)pyridine-3 -carboxamide), Pfizer UK 500,001, Piclamilast (3-(cyclopentyloxy)-N-(3,5-dichloiO-4-pyridinyl)-4-methoxy- benzamide), PLX-369 (WO 2006026754), Roflumilast (3-(cyclopropylmethoxy)-N-(3,5- dichloro-4-pyridinyl)-4-(difluoromethoxy)benzaniide), SCH 351591 (N-(3,5-dichloro-l- oxido-4-pyridinyl)-8-methoxy-2-(trifluoromethyl)-5-quinolinecarboxamide), SeICID(TM) CC- 10004 (Calgene), T-440 (Tanabe), Tetomilast (6-[2-(3,4-diethoxyphenyl)-4-thiazolyl]- 2-pyridinecarboxylic acid), Tofimilast (9-cyclopentyl-7-ethyl-6,9-dihydro-3-(2-thienyl)- 5H-pyrazolo[3,4-c]-l,2,4-triazolo[4,3-a]pyridine), TPI 1100, UCB 101333-3 (N,2- dicyclopropyl-6-(hexahydro-lH-azepin-l-yl)-5-methyl-4-pyrimidinamine), V-11294A (Napp), VM554/VM565 (Vernalis), or Zardaverine (6-[4-(difluoromethoxy)-3- methoxyphenyl]-3(2H)-pyridazinone); or a PDE5 Inhibitor, for example, Gamma- glutamyl[s-(2-iodobenzyl)cysteinyl]glycine, Tadalafil, Vardenafϊl, sildenafil, 4-phenyl- methy lamino-6-chloro-2-( 1 -imidazolyl)-quinazoline, 4-phenyl-methylamino-6-chloro-2- (3-pyridyl)-quinazoline, 1 ,3-dimethyl-6-(2-propoxy-5-methanesulphonylamidophenyl)- l,5-dihydropyrazolo[3,4-d]pyrimidin-4-one or l-cyclopentyl-3-ethyl-6-(3-ethoxy-4- pyridyl)-pyrazolo[3,4-d]pyrimidin-4-one}.

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is N-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol-7-yl)ethyl]amino}ethyl)-3-[2-(3- chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is a PDE4 inhibitor, for example, 256066, Arofylline (3-(4-chlorophenyl)-3,7-dihydro-l- propyl-lH-Purine-2,6-dione), AWD 12-281 (N-(3,5-dichloro-4-pyridinyl)-l-[(4- fluorophenyl)methyl]-5-hydroxy-α-oxo-lH-indole-3-acetamide), BAY19-8004 (Bayer), CDC-801 (Calgene), Celgene compound ((βR)-β-(3,4-dimemoxyphenyl)-l,3-dihydro-l- oxo-2H-isoindole-2-propanamide), Cilomilast (cis-4-cyano~4-[3-(cyclopentyloxy)-4- methoxyphenylj-cyclohexanecarboxylic acid), a compound in WO2006098353 from Kyowa Hakko Kogyo Co. Ltd. Japan, 2-(3,5-dichloro-4-pyridinyl)-l-(7-methoxyspiro[l,3- benzodioxole-2, 1 '-cyclopentan]-4-yl)ethanone (CAS number 185406-34-2)), Compound from Pfizer (2-(3,4-difluorophenoxy)-5-fluoro-N-[cis-4-[(2-hydroxy-5- methylbenzoyl)amino]cyclohexyl]-)-3-pyridinecarboxamide), Compound from Pfizer (2- (3,4-difluorophenoxy)-5-fluoro-N-[cis-4-[[2-hydroxy-5-

(hydroxymethy^benzoylJaminoJcyclohexylJ-S-pyridinecarboxamide,), CT2820, GPD- 1116, Ibudilast, IC 485, KF 31334, KW-4490 (Kyowa Hakko Kogyo), Lirimilast ([2-(2,4- dichlorobenzoyl)-6-[(methylsulfonyl)oxy]-3-benzofuranyl])-urea), Merck Compound (N- cyclopropyl- 1 ,4-dihydro-4-oxo- 1 - [3 -(3 -pyridinylethynyl)phenyl] -)- 1 ,8-naphthyridine-3 - carboxamide), Oglemilast (N-(3,5-dichloro-4-pyridinyl)-4-(difluoromethoxy)-8- [(methylsulfonyl)amino])-l-dibenzofurancarboxamide), ONO6126, ORG 20241 (4-(3,4- dimethoxyphenyl)-N-hydroxy-)-2-thiazolecarboximidamide), PD189659/PD168787 (Parke-Davis), Pentoxifylline (3 ,7-dihydro-3 ,7-dimethyl- 1 -(5-oxohexyl)-)- 1 H-purine-2,6- dione), Pfizer compound (5-fluoro-N-[4-[(2-hydroxy-4-methyl- benzoyl)amino]cyclohexyl]-2-(thian-4-yloxy)pyridine-3-carboxamide), Pfizer UK 500,001, Piclamilast (3-(cyclopentyloxy)-N-(3,5-dichloro-4-pyridinyl)-4-methoxy- benzamide), PLX-369 (WO 2006026754), Roflumilast (3-(cyclopropylmethoxy)-N-(3,5- dichloro-4-pyridinyl)-4-(difluoromethoxy)benzamide), SCH 351591 (N-(3,5-dichloro-l- oxido-4-pyridiny I)- 8 -methoxy-2-(trifluoromethy I)- 5 -quinolinecarboxamide), S elCID(TM) CC-10004 (Calgene), T-440 (Tanabe), Tetomilast (6-[2-(3,4-diethoxyphenyl)-4-thiazolyl]- 2-pyridinecarboxylic acid), Tofimilast (9-cyclopentyl-7-ethyl-6,9-dihydro-3-(2-thienyl)- 5H-pyrazolo[3,4-c]-l,2,4-triazolo[4,3-a]pyridine), TPI 1100, UCB 101333-3 (N,2- dicyclopropyl-6-(hexahydro- 1 H-azepin- 1 -yl)-5-methyl-4-pyrimidinamine), V-I l 294 A (Napp), VM554/VM565 (Vernalis), or Zardaverine (6-[4-(difluoromethoxy)-3- methoxyphenyl]-3(2H)-pyridazinone).

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is iV-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl]amino } ethyl)-3 - [2-(3 - chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is a PDE4 inhibitor, for example AWD 12-281 (N-(3,5-dichloro-4-pyridinyl)-l-[(4- fluorophenyl)methyl]-5-hydroxy-α-oxo-lH-indole-3-acetamide) or roflumilast.

In another aspect the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is iV-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol-7-yl)ethyl]amino}ethyl)-3-[2-(3- chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient is roflumilast.

The first active ingredient and the second active ingredient of the pharmaceutical product of the present invention may be administered simultaneously, sequentially or separately to treat respiratory diseases. By simultaneously is meant that the active ingredients are in admixture, or they could be in separate chambers of the same inhaler. By sequential it is meant that the active ingredients are administered, in any order, one immediately after the other. They still have the desired effect if they are administered separately, but when administered in this manner they are generally administered less than 4 hours apart, conveniently less than two hours apart, more conveniently less than 30 minutes apart and most conveniently less than 10 minutes apart, for example less than 10 minutes but not one immediately after the other.

The active ingredients of the present invention may be administered by oral or parenteral (e.g. intravenous, subcutaneous, intramuscular or intraarticular) administration using conventional systemic dosage forms, such as tablets, capsules, pills, powders, aqueous or oily solutions or suspensions, emulsions and sterile injectable aqueous or oily solutions or suspensions. The active ingredients may be delivered to the lung and/or airways via oral administration in the form of a solution, suspension, aerosol or dry powder formulation. These dosage forms will usually include one or more pharmaceutically acceptable ingredients which may be selected, for example, from an adjuvant, carrier, binder, lubricant, diluent, stabilising agent, buffering agent, emulsifying agent, viscosity- regulating agent, surfactant, preservative, flavouring or colorant. As will be understood by those skilled in the art, the most appropriate method of administering the active ingredients is dependent on a number of factors.

In another embodiment the active ingredients are administered via a single pharmaceutical composition (that is, the first and second active ingredients are in admixture). Therefore, the present invention further provides a pharmaceutical composition comprising, in admixture, a first active ingredient which is iV-[2-(Diethylamino)ethyl]-N-(2-{[2-(4- hydroxy-2-oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl]amino } ethyl)-3 - [2-(3 - chlorophenyl)ethoxy]propanamide dihydrobromide, and a second active ingredient as defined above. The pharmaceutical composition optionally further comprises a pharmaceutically acceptable adjuvant, diluent or carrier.

The pharmaceutical compositions of the present invention can be prepared by mixing the first active ingredient with the second active ingredient and a pharmaceutically acceptable adjuvant, diluent or carrier. Therefore, in a further aspect of the present invention there is provided a process for the preparation of a pharmaceutical composition, which comprises mixing the first and second active ingredients and a pharmaceutically acceptable adjuvant, diluent or carrier.

It will be understood that the therapeutic dose of each active ingredient administered in accordance with the present invention will vary depending upon the particular active ingredient employed, the mode by which the active ingredient is to be administered, and the condition or disorder to be treated.

In one embodiment of the present invention, the first active ingredient is administered via inhalation. When administered via inhalation the dose of the first active ingredient will generally be in the range of from 0.1 microgram (μg) to 5000 μg, 0.1 to 1000 μg, 0.1 to 500 μg, 0.1 to 100 μg, 0.1 to 50 μg, 0.1 to 5 μg, 5 to 5000 μg, 5 to 1000 μg, 5 to 500 μg, 5 to 100 μg, 5 to 50 μg, 5 to 10 μg, 10 to 5000 μg, 10 to 1000 μg, 10 to 500 μg, 10 to 100 μg, 10 to 50 μg, 20 to 5000 μg, 20 to 1000 μg, 20 to 500 μg, 20 to 100 μg, 20 to 50 μg, 50 to 5000 μg, 50 to 1000 μg, 50 to 500 μg, 50 to 100 μg, 100 to 5000 μg, 100 to 1000 μg or 100 to 500 μg. The dose will generally be administered from 1 to 4 times a day, conveniently once or twice a day, and most conveniently once a day.

In one embodiment of the present invention the second active ingredient is administered by inhalation. When administered via inhalation the dose of the second active ingredient will generally be in the range of from 0.1 microgram (μg) to 5000 μg, 0.1 to 1000 μg, 0.1 to 500 μg, 0.1 to 100 μg, 0.1 to 50 μg, 0.1 to 5 μg, 5 to 5000 μg, 5 to 1000 μg, 5 to 500 μg, 5 to 100 μg, 5 to 50 μg, 5 to 10 μg, 10 to 5000 μg, 10 to 1000 μg, 10 to 500 μg, 10 to 100 μg, 10 to 50 μg, 20 to 5000 μg, 20 to 1000 μg, 20 to 500 μg, 20 to 100 μg, 20 to 50 μg, 50 to 5000 μg, 50 to 1000 μg, 50 to 500 μg, 50 to 100 μg, 100 to 5000 μg, 100 to 1000 μg or 100 to 500 μg. The dose will generally be administered from 1 to 4 times a day, conveniently once or twice a day, and most conveniently once a day.

I another embodiment the present invention provides a pharmaceutical product wherein the molar ratio of first active ingredient to second active ingredient is from 1 : 1000 to 1000:1, such as from 1:100 to 100:1, for example from 1 :50 to 50:1, for example 1:20 to 20:1.

In one embodiment, the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient as defined above, and a second active ingredient as defined above, wherein each active ingredient is formulated for inhaled administration. In a further aspect of this embodiment, the pharmaceutical product is in the form of a pharmaceutical composition comprising the first and second active ingredients in admixture, and which composition is formulated for inhaled administration.

The active ingredients of the present invention are conveniently delivered via oral administration by inhalation to the lung and/or airways in the form of a solution, suspension, aerosol or dry powder (such as an agglomerated or ordered mixture) formulation. For example a metered dose inhaler device may be used to administer the active ingredients, dispersed in a suitable propellant and with or without an additional excipient such as ethanol, a surfactant, lubricant or stabilising agent. A suitable propellant includes a hydrocarbon, chlorofluorocarbon or a hydrofluoroalkane (e.g. heptafluoroalkane) propellant, or a mixture of any such propellants, for example in a pressurised metered dose inhaler (pMDI). Preferred propellants are P 134a and P227, each of which may be used alone or in combination with other another propellant and/or surfactant and/or other excipient. A nebulised aqueous suspension or, preferably, solution may also be employed, with or without a suitable pH and/or tonicity adjustment, either as a unit-dose or multi-dose formulation. A suitable device for delivering a dry powder is Turbuhaler®. The pharmaceutical product of the present invention can, for example, be administered: via an inhaler having the first and second active ingredients in separate chambers of the inhaler such that on administration the active ingredients mix in either the mouthpiece of the inhaler or the mouth of a patient or both (for simultaneous use); or, where the first and second active ingredients are in separate inhalers, via separate inhalers (for separate or sequential use); or the first and second active ingredients are in admixture in an inhaler when the inhaler is supplied to a patient (for simultaneous use).

A dry powder inhaler may be used to administer the active ingredients, alone or in combination with a pharmaceutically acceptable carrier (such as lactose), in the later case either as a finely divided powder or as an ordered mixture. The dry powder inhaler may be single dose or multi-dose and may utilise a dry powder or a powder-containing capsule.

Metered dose inhaler, nebuliser and dry powder inhaler devices are well known and a variety of such devices are available.

The pharmaceutical product of the present invention may be used to treat diseases of the respiratory tract such as obstructive diseases of the airways including: asthma, including bronchial, allergic, intrinsic, extrinsic, exercise-induced, drug-induced (including aspirin and NSAID-induced) and dust-induced asthma, both intermittent and persistent and of all severities, and other causes of airway hyper-responsiveness; chronic obstructive pulmonary disease (COPD); bronchitis, including infectious and eosinophilic bronchitis; emphysema; bronchiectasis; cystic fibrosis; sarcoidosis; farmer's lung and related diseases; hypersensitivity pneumonitis; lung fibrosis, including cryptogenic fibrosing alveolitis, idiopathic interstitial pneumonias, fibrosis complicating anti-neoplastic therapy and chronic infection, including tuberculosis and aspergillosis and other fungal infections; complications of lung transplantation; vasculitic and thrombotic disorders of the lung vasculature, and pulmonary hypertension; antitussive activity including treatment of chronic cough associated with inflammatory and secretory conditions of the airways, and iatrogenic cough; acute and chronic rhinitis including rhinitis medicamentosa, and vasomotor rhinitis; perennial and seasonal allergic rhinitis including rhinitis nervosa (hay fever); nasal polyposis; acute viral infection including the common cold, and infection due to respiratory syncytial virus, influenza, coronavirus (including SARS) and adenovirus.

Accordingly, the present invention further provides a pharmaceutical product, kit or pharmaceutical composition according to the invention for simultaneous, sequential or separate use in therapy.

The present invention further provides the use of a pharmaceutical product according to the invention in the manufacture of a medicament for the treatment of a respiratory disease, in particular chronic obstructive pulmonary disease, asthma, rhinitis, emphysema or bronchitis (such as chronic obstructive pulmonary disease or asthma; for example chronic obstructive pulmonary disease; in particular chronic obstructive pulmonary disease or asthma).

The present invention still further provides a method of treating a respiratory disease which comprises simultaneously, sequentially or separately administering:

(a) a (therapeutically effective) dose of a first active ingredient as defined above; and,

(b) a (therapeutically effective) dose of a second active ingredient as defined above; to a patient in need thereof.

In the context of the present specification, the term "therapy" also includes "prophylaxis" unless there are specific indications to the contrary. The terms "therapeutic" and "therapeutically" should be construed accordingly. Prophylaxis is expected to be particularly relevant to the treatment of persons who have suffered a previous episode of, or are otherwise considered to be at increased risk of, the condition or disorder in question. Persons at risk of developing a particular condition or disorder generally include those having a family history of the condition or disorder, or those who have been identified by genetic testing or screening to be particularly susceptible to developing the condition or disorder. General Preparative Methods

¹H NMR spectra were recorded on a Varian Inova 400 MHz or a Varian Mercury-YX 300 MHz instrument. The central peaks of chloroform-d (δπ 7.27 ppm), dimethylsulfoxide-^ (5_H 2.50 ppm), acetonitrile-Jj (δπ 1.95 ppm) or methanol-^ (δπ 3.31 ppm) were used as internal references. Column chromatography was carried out using silica gel (0.040-0.063 mm, Merck). Unless stated otherwise, starting materials were commercially available. All solvents and commercial reagents were of laboratory grade and were used as received.

The following method was used for LC/MS analysis: Instrument Agilent 1100; Column Waters Symmetry 2.1 x 30 mm; Mass APCI; Flow rate 0.7 ml/min; Wavelength 254 nm; Solvent A: water + 0.1% TFA; Solvent B: acetonitrile + 0.1% TFA ; Gradient 15-95%/B 8 min, 95% B 1 min.

Analytical chromatography was run on a Symmetry C₁₈-column, 2.1 x 30 mm with 3.5 μm particle size, with acetonitrile/water/0.1% trifluoroacetic acid as mobile phase in a gradient from 5% to 95% acetonitrile over 8 minutes at a flow of 0.7 ml/min.

The abbreviations or terms used in the examples have the following meanings: SCX: Solid phase extraction with a sulfonic acid sorbent HPLC: High performance liquid chromatography DMF: ΛζN-Dimethylformamide

The β₂-adrenoceptor agonists and the intermediates used in their preparation are herein named, based upon the structures depicted, using the IUPAC NAME, ACD Labs Version 8 naming package.

In the Figures:

Figure 1 Histamine- induced bronchoconstriction in the guinea pig. Guinea pigs were dosed with either vehicle, 1 μg/kg and 27μg/kg Compound AA, lmg/kg roflumilast or a combination of 1 μg/kg Compound AA and lmg/kg roflumilast

2 hours prior to histamine challenge. Figure 2 Methacholine- induced bronchoconstriction in the guinea pig. Guinea pigs were dosed with vehicle, 0.42 μg/kg and 14μg/kg Compound AA, O.lμg/kg tiotropium bromide or a combination of 0.42 μg/kg Compound AA and O.lμg/kg tiotropium bromide 2 hours prior to methacholine challenge. Figure 3 Onset times for roflumilast (lμM), Compound AA (6.3nM) and Compound AA (6.3nM) in the presence of roflumilast (lμM) in guinea pig trachea in vitro.

Figure 4 Cumulative concentration-response curves to compound AA in the presence of vehicle and roflumilast (1OnM, 10OnM and lμM) in guinea pig trachea in vitro.

Preparation 1

N-f2-(Diethylamino)ethyn-N-(2-{[2-(4-hvdroxy-2-oxo-2,3-dihydro-l,3-benzothiazoI-7- yPethyli amino! ethyl)-3-[2-(3-chlorophenyl)ethoxylpropanamide dihydrobromide (Compound AA)

a) tert-Butyl 3-[2-(3-chlorophenyl)ethoxy]propanoate

2-(3-chlorophenyl)ethanol (20 g) was treated with benzyltrimethylammonium hydroxide (Triton B^®) (2.67 niL) and the resultant mixture was stirred in vacuo for 30 minutes. The mixture was then cooled to 0°C and treated with t-butyl acrylate (17.40 g). The reaction was warmed to room temperature and stirred for 16 hours. The mixture was filtered through aluminium oxide (15 g) eluting with ether (75 niL). The collected filtrate was concentrated to give the sub-titled compound (34.40 g) as an oil.

¹H NMR (CDCl₃) δ 726-7.07 (m, 4H), 3.69-3.59 (m, 4H), 2.86-2.81 (t, 2H), 2.50-2.45 (t, 2H), 1.43 (s, 9H)

b) 3- [2-(3-chlorophenyl)ethoxy] propanoic acid tert-Butyl 3-[2-(3-chlorophenyi)ethoxy]propanoate (example Ia), 34.40 g) was dissolved in dichloromethane (150 mL) and treated with trifluoroacetic acid (50 mL). The mixture was stirred at room temperature for 3 hours, then concentrated in vacuo and azeotroped with dichloromethane (2 x 10 mL). The residue was taken up in dichlormethane (300 mL) and extracted with saturated sodium hydrogen carbonate (200 mL). The basic layer was washed with dichloromethane (20 mL) then acidified with 2M hydrochloric acid. The acidic layer was extracted with dichloromethane (2 x 200 mL). The organic layers were combined, washed with brine, dried over anhydrous magnesium sulphate, filtered and concentrated to yield the sub-titled compound (24.50 g) as an oil. m/e 227 [M-H]

c)iV-[2-(Diethylamino)ethyI]-iV-(2,2-diinethoxyethyl)-3-[2-(3- chloropheny I)ethoxy] propanamide

Oxalyl chloride (9.50 mL) was added dropwise over 45 minutes to a solution of 3-[2-(3- chlrophenyl)ethoxy]propanoic acid (22.50 g) (example Ib) in dichloromethane (120ml) and DMF (0.5 mL). The reaction mixture was stirred for a further 16 hours. The mixture was subsequently concentrated, redissolved in DCM (1.7 L) and added dropwise over 1.75 hours at O⁰C to a solution of Λ^-(2,2-dimethoxyethyl)-iV,Λf-diethylethane- 1 ,2-diamine (20.20 gXexample 16a) and isopropyldiethylamine (34.43 mL) in DCM (200 mL). The resulting mixture was stirred at room temperature for 16 hours, washed with aqueous saturated sodium bicarbonate solution (3x1 L), water (1.5 L) and dried over sodium sulphate and concentrated to give 39.50 g of the sub-titled compound. m/e 415 (M+H⁺, 83%)

d)7V-[2-(Diethylamino)ethyI]-3-[2-(3-chlorophenyl)ethoxy]-iV-(2- oxoethyl)propanamide

A solution of N- [2-(Diethylamino)ethyl]-iV-(2,2-dimetlioxyethyl)-3 - [2-(3 - chlorophenyl)ethoxy]propanamide (example Ic) (20 g) in DCM (500 mL) was treated dropwise at O⁰C with trifluoroacetic acid (50 mL) over 30 minutes. After the addition the reaction mixture was allowed to warm to room temperature and stirred for a further 1 hour. The reaction mixture was concentrated and the residue poured into aqueous saturated sodium bicarbonate solution (1800 mL, caution). The aqueous mixture was extracted with DCM (3x400 mL) and the combined extracts were dried over magnesium sulphate and concentrated. The residue was used directly in the following reaction.

e)iV-[2-(Diethylamino)ethyI]-N-(2-{[2-(4-hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol- 7-yI)ethyl]amino}ethyl)-3-[2-(3-chlorophenyl)ethoxy]propanamide dihydrobromide

A suspension of 7-(2-amino-ethyl)-4-hydroxy-3H-benzothiazol-2-one hydrochloride (11.77 g) in dry NMP (50 mL) was heated to 65⁰C and treated in one portion with a solution of NaOH (1.83 g) in methanol (23 mL). The bright orange suspension was cooled to room temperature and treated dropwise with a solution of N-[2-(diethylamino)ethyl]-3- [2-(3-chlorophenyl)ethoxy]-N-(2-oxoethyl)propanamide (example Id) in dichloromethane (50 mL) over 30 minutes. The reaction was left to stir for 30 minutes. Sodium triacetoxyborohydride (20.33 g) was then added in portions over 20 minutes and the mixture stirred for a further 16 hours. The reaction mixture was poured into water (1.8 L), basified to pH8 by the addition of solid potassium carbonate and extracted with dichloromethane (2x500 mL); the combined organic extracts were dried over magnesium sulphate and concentrated to give a dark oil. The residue was purified by chromatography on silica with 10% (0.1% aqNH₃/Me0H)/DCM as eluent to give the sub-title compound as a brown oil. Yield (6.58 g). This was dissolved in ethanol (150 mL) and 48% aqueous hydrobromic acid (10 mL) was added. The solution was aged for 30 minutes then evaporated to dryness. The residue was triturated with ethanol (100 mL); the resultant solid was collected by filtration and dried in vacuo at 50. This material was recrystallised from ethanol/water (6:1, 500 mL); after standing overnight the resultant solid was collected by filtration and washed with ice-cold ethanol (75 niL). Drying in vacuo at 5O⁰C for 24hr afforded 4.96 g of the title compound. MS: APCI (+ve): 563 (M+l) 99.3% purity (T9505M).

¹H NMR (DMSO, 90°C), δ 11.75-11.73 (m, IH), 10.08-10.06 (d, IH), 8.65 (bs, IH), 7.33- s 7.19 (m, 4H), 6.89-6.84 (t, IH), 6.77-6.74 (m, IH), 3.68-3.58 (m, 8H), 3.17-3.16 (m, 10H), 2.86-2.80 (m, 4H), 2.67-2.62 (m, 2H), 1.23-1.19 (t, 6H). Elemental Analysis CHNS C:46.54%(46.39);H:5.75%(5.70);N:7.94%(7.73);S:4.46%(4.42)

10

Alternative salts of iV-[2-(Diethylainino)ethyl]-iV-(2-{ [2-(4-hydroxy-2-oxo-2,3-dihydro- 1 ,3 -benzothiazol-7-yl)ethyl] amino } ethyl)-3 - [2-(3 -chlorophenyl)ethoxy]propanamide can be prepared by mixing a suitable acid with N-[2-(Diethylamino)ethyl]-iV-(2-{[2-(4- hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol-7-yl)ethyl]amino}ethyl)-3-[2-(3- i₅ chlorophenyl)ethoxy]propanamide in a solvent.

Adrenergic β2 mediated cAMP production

Cell preparation

20 H292 cells were grown in 225cm2 flasks incubator at 37°C, 5% CO₂ in RPMI medium containing, 10% (v/v) FBS (foetal bovine serum) and 2 mM L-glutamine.

Experimental Method

Adherent H292 cells were removed from tissue culture flasks by treatment with 2₅ Accutase^τ cell detachment solution for 15 minutes. Flasks were incubated for 15 minutes in a humidified incubator at 37°C, 5% CO₂. Detached cells were re-suspended in RPMI media (containing 10% (v/v) FBS and 2 mM L-glutamine) at 0.05 x 10⁶ cells per mL.

5000 cells in 100 μL were added to each well of a tissue-culture-treated 96-well plate and the cells incubated overnight in a humidified incubator at 37°C, 5% CO₂. The culture 30 media was removed and cells were washed twice with 100 μL assay buffer and replaced with 50 μL assay buffer (HBSS solution containing 1OmM HEPES pH7.4 and 5 mM glucose). Cells were rested at room temperature for 20 minutes after which time 25 μL of rolipram (1.2 mM made up in assay buffer containing 2.4% (v/v) dimethylsulphoxide) was added. Cells were incubated with rolipram for 10 minutes after which time Compound A was added and the cells were incubated for 60 minutes at room temperature. The final rolipram concentration in the assay was 300 μM and final vehicle concentration was 1.6% (v/v) dimethylsulphoxide. The reaction was stopped by removing supernatants, washing once with 100 μL assay buffer and replacing with 50 μL lysis buffer. The cell monolayer was frozen at -80°C for 30 minutes (or overnight).

AlphaScreen™ cAMP detection

The concentration of cAMP (cyclic adenosine monophosphate) in the cell lysate was determined using AlphaScreen™ methodology. The frozen cell plate was thawed for 20 minutes on a plate shaker then 10 μL of the cell lysate was transferred to a 96-well white plate. 40 μL of mixed AlphaScreen™ detection beads pre-incubated with biotinylated cAMP, was added to each well and the plate incubated at room temperature for 10 hours in the dark. The AlphaScreen™ signal was measured using an En Vision spectrophotometer (Perkin-Elmer Inc.) with the recommended manufacturer's settings. cAMP concentrations were determined by reference to a calibration curve determined in the same experiment using standard cAMP concentrations. A concentration response curve for Compound A was constructed and data was fitted to a four parameter logistic equation to determine both the pEC₅₀ and Intrinsic Activity. Intrinsic Activity was expressed as a fraction relative to the maximum activity determined for formoterol in each experiment. A result for Compound A is in Table 1.

Selectivity Assays

Adrenergic αlD

Membrane Preparation Membranes were prepared from human embryonic kidney 293 (HEK293) cells expressing recombinant human αl_D receptor. These were diluted in Assay Buffer (5OmM HEPES, ImM EDTA, 0.1% gelatin, pH 7.4) to provide a final concentration of membranes that gave a clear window between maximum and minimum specific binding.

Experimental Method Assays were performed in U-bottomed 96-well polypropylene plates. 10 μL [³H]-prazosin (0.3 nM final concentration) and 10 μL of Compound A (1Ox final concentration) were added to each test well. For each assay plate 8 replicates were obtained for [³H] -prazosin binding in the presence of 10 μL vehicle (10% (v/v) DMSO in Assay Buffer; defining maximum binding) or lOμL BMY7378 (10 μM final concentration; defining non-specific binding (NSB)). Membranes were then added to achieve a final volume of 100 μL. The plates were incubated for 2 hours at room temperature and then filtered onto PEI coated GF/B filter plates, pre-soaked for 1 hour in Assay Buffer, using a 96-well plate Tomtec cell harvester. Five washes with 250 μL wash buffer (5OmM HEPES, ImM EDTA, pH 7.4) were performed at 4⁰C to remove unbound radioactivity. The plates were dried then sealed from underneath using Packard plate sealers and MicroScint-0 (50 μL) was added to each well. The plates were sealed (TopSeal A) and filter-bound radioactivity was measured with a scintillation counter (TopCount, Packard BioScience) using a 3-minute counting protocol.

Total specific binding (B₀) was determined by subtracting the mean NSB from the mean maximum binding. NSB values were also subtracted from values from all other wells. These data were expressed as percent of B₀. Compound concentration-effect curves (inhibition of [³H] -prazosin binding) were determined using serial dilutions typically in the range 0.1 nM to 10 μM. Data was fitted to a four parameter logistic equation to determine the compound potency, which was expressed as pIC50 (negative log molar concentration inducing 50% inhibition of [³H]-prazosin binding).

Adrenergic βl Membrane Preparation

Membranes containing recombinant human adrenergic beta 1 receptors were obtained from Euroscreen. These were diluted in Assay Buffer (5OmM HEPES, ImM EDTA, 12OmM NaCl, 0.1% gelatin, pH 7.4) to provide a final concentration of membranes that gave a clear window between maximum and minimum specific binding.

Experimental Method

Assays were performed in U-bottomed 96-well polypropylene plates. 10 μL [¹²⁵I]-

Iodocyanopindolol (0.036 nM final concentration) and 10 μL of Compound A (10x final concentration) were added to each test well. For each assay plate 8 replicates were obtained for [¹²⁵I]-Iodocyanopindolol binding in the presence of 10 μL vehicle (10% (v/v) DMSO in Assay Buffer; defining maximum binding) or 10 μL Propranolol (10 μM final concentration; defining non-specific binding (NSB)). Membranes were then added to achieve a final volume of 100 μL. The plates were incubated for 2 hours at room temperature and then filtered onto PEI coated GF/B filter plates, pre-soaked for 1 hour in Assay Buffer, using a 96-well plate Tomtec cell harvester. Five washes with 250 μL wash buffer (5OmM HEPES₅ ImM EDTA, 12OmM NaCl, pH 7.4) were performed at 4°C to remove unbound radioactivity. The plates were dried then sealed from underneath using Packard plate sealers and MicroScint-0 (50 μL) was added to each well. The plates were sealed (TopSeal A) and filter-bound radioactivity was measured with a scintillation counter (TopCount, Packard BioScience) using a 3 -minute counting protocol.

Total specific binding (B₀) was determined by subtracting the mean NSB from the mean maximum binding. NSB values were also subtracted from values from all other wells. These data were expressed as percent of B₀. Compound concentration-effect curves (inhibition of [¹²⁵I]-Iodocyanopindolol binding) were determined using serial dilutions typically in the range 0.1 nM to 10 μM. Data was fitted to a four parameter logistic equation to determine the compound potency, which was expressed as pi C₅₀ (negative log molar concentration inducing 50% inhibition of [^I25I]-Iodocyanopindolol binding). Dopamine D2

Membrane Preparation

Membranes containing recombinant human Dopamine Subtype D2s receptors were obtained from Perkin Elmer. These were diluted in Assay Buffer (5OmM HEPES, ImM EDTA, 12OmM NaCl, 0.1% gelatin, pH 7.4) to provide a final concentration of membranes that gave a clear window between maximum and minimum specific binding.

Experimental Method Assays were performed in U-bottomed 96-well polypropylene plates. 30 μL [³H]- spiperone (0.16 nM final concentration) and 30 μL of Compound A (10x final concentration) were added to each test well. For each assay plate 8 replicates were obtained for [³H] -spiperone binding in the presence of 30 μL vehicle (10% (v/v) DMSO in Assay Buffer; defining maximum binding) or 30 μL Haloperidol (10 μM final concentration; defining non-specific binding (NSB)). Membranes were then added to achieve a final volume of 300 μL. The plates were incubated for 2 hours at room temperature and then filtered onto PEI coated GF/B filter plates, pre-soaked for 1 hour in Assay Buffer, using a 96-well plate Tomtec cell harvester. Five washes with 250 μL wash buffer (5OmM HEPES, ImM EDTA, 12OmM NaCl, pH 7.4) were performed at 4°C to remove unbound radioactivity. The plates were dried then sealed from underneath using Packard plate sealers and MicroScint-0 (50 μL) was added to each well. The plates were sealed (TopSeal A) and filter-bound radioactivity was measured with a scintillation counter (TopCount, Packard BioScience) using a 3 -minute counting protocol.

Total specific binding (B₀) was determined by subtracting the mean NSB from the mean maximum binding. NSB values were also subtracted from values from all other wells. These data were expressed as percent of B₀. Compound concentration-effect curves (inhibition of [³H]-spiperone binding) were determined using serial dilutions typically in the range 0.1 nM to 10 μM. Data was fitted to a four parameter logistic equation to determine the compound potency, which was expressed as pIC₅₀ (negative log molar concentration inducing 50% inhibition of [³H]-spiperone binding). 1 We 1

Compound β2 pEC50 β2 Int Act αl bind pIC50 βl bind p IC50 D2 bind pIC50

A 8.3 0.7 <6. 1 <5 5.6

The present invention will now be further explained by reference to the following illustrative Examples.

Example 1

Evaluation of compound activity on intra-alveolar neutrophil migration after aerosol challenge with lippopolysaccharride (LPS) in the CRL:CD rat. LPS challenge in CRL:CD rats causes an influx of inflammatory cells into the lungs. Rats are challenged either with an aerosol of 0.9% w/v saline or O.lmg/mL LPS in 0.9% saline for 30 min or an intratracheal dose of 0.1-1 Oμg/kg. This is repeated up to 8 times according to the experimental protocol. Rats are dosed with vehicle, standard compound or test compound by the appropriate route and frequency at various time points before and after challenge depending upon the experimental protocol. Test compound groups could either be the same compound at different doses or single doses of different compounds or a combination of the two. Test compounds are given by intraperitoneal, intravenous or subcutaneous injection or by inhalation or intratracheal administration.

The rats are euthanized at various time points after challenge depending upon the nature of the study, but typically 4hr after LPS challenge with ImL pentobarbitone sodium. A tracheotomy is performed and a cannula inserted. The airway is then lavaged using 3 rnL sterile PBS at room temperature. The PBS is left in the airway for 10 seconds before being removed. The PBS containing cells is placed into a 15 mL centrifuge tube on ice. This process is repeated three times.

An aliquot of BAL fluid is removed and counted on Sysmex (Sysmex UK, Milton Keynes). Cytospin slides are prepared by adding a 100 μl aliquot of BAL fluid into cytospin funnels in a Shandon Cytospin3 operated at 700 rpm for 5 min. Slides are stained on the Hema-Tek-2000 automatic slide stainer, using Wright-Giemsa stain and typically, 200 cells are counted under a microscope. Cells are classified as eosinophils, neutrophils and mononuclear cells (mononuclear cells included monocytes, macrophages and lymphocytes) and are expressed as a percentage of the total count.

5 Example 2

Evaluation of compound activity on intra-alveolar neutrophil migration after aerosol challenge with lippopolysaccharride (LPS) in the guinea-pig.

Male Dunkin-Hartley guinea-pigs (300-60Og) are placed into open fronted guinea-pig holding cones attached at random around a cylindrical aerosol chamber. Guinea-pigs are io held in the challenge cones and exposed to an aerosol of vehicle, or LPS at concentrations of 0.1-30μg/ml in 0.9%saline per group Aerosols are generated using 2 jet nebulisers per column with a flow rate of 12 L/m. 10ml of the challenge agent is placed into each nebuliser. Alternatively animals receive an intratracheal dose of 0.1-1 Oμg/kg. This is repeated up to 8 times according to the experimental protocol.

I₅

Guinea-pigs are dosed with vehicle, standard compound or test compound by the appropriate route and frequency at various time points before and after challenge depending upon the experimental protocol. Test compound groups could either be the same compound at different doses or single doses of different compounds or a combination

20 of the two. Test compounds are given by intraperitoneal, intravenous or subcutaneous injection or by inhalation or intratracheal administration. Challenged guinea-pigs are killed by anaesthesia overdose (0.5ml Euthetal i.p.) at 4h-24h post challenge. The lungs are then lavaged. After the trachea is exposed and cannulated using a luer fitting cannula (orange =size 8FG), the lungs are lavaged with 3 x 5ml aliquots of Hanks Buffered Salt

2s Solution (HBSS, EDTA -free). The lavaging is performed with gentle massaging of the chest to ensure appropriate agitation of the fluid in the lungs. The washes are harvested into a 15ml conical, polypropylene centrifuge tube, an aliquot of BAL fluid is removed and counted on Sysmex (Sysmex UK, Milton Keynes). Cytospin slides are prepared by adding a 100 μl aliquot of BAL fluid into cytospin funnels in a Shandon Cytospin3 operated at

30 700 rpm for 5 min. Slides are stained on the Hema-Tek-2000 automatic slide stainer, using Wright-Giemsa stain and typically, 200 cells are counted under a microscope. Cells are classified as eosinophils, neutrophils and mononuclear cells (mononuclear cells included monocytes, macrophages and lymphocytes) and are expressed as a percentage of the total count.

Example 3 Evaluation of compound activity on intra-alveolar neutrophil migration after aerosol challenge with lippopolysaccharride (LPS) in the mouse.

Male C57BL/6/J or BALB/C mice (20-35g) are placed in Perspex exposure boxes in groups of up to 20 and exposed to an aerosol of either 0.3 mg/ml LPS or 0.9% w/v saline. The LPS (Sigma, E.Coli, Ref L-3755, Serotype 026:B6, Lot no. 11 lk4078) is made up in 0.9% w/v saline. An aerosol is generated using two jet nebulisers operated at a flow rate of 12 L/min (6L/min for each nebuliser) for 15 min. Alternatively animals receive an intratracheal dose of 0.1-10μg/kg. This may be repeated up to 8 times.

Mice are dosed with vehicle, standard compound or test compound by the appropriate route and frequency at various time points before and after challenge depending upon the experimental protocol. Test compound groups could either be the same compound at different doses or single doses of different compounds or a combination of the two. Test compounds are given by intraperitoneal, intravenous or subcutaneous injection or by inhalation or intratracheal administration.

Mice are killed with an overdose of Euthatal i.p 30 minutes, 1— 24hr after LPS challenge. When circulation has ceased, the trachea is cannulated (Portex intravenous cannula) and the airways lavaged with 3 x 0.3ml of Isoton II (Beckman Coulter Ref. 8448011 Lot no.25775). For cytospins, lOOμl of the BALF is added to a cytospin funnel and spun, using a ThermoShandon Cytospin model 3 or 4, at 700 rpm for 5 min. Cells on the slide are stained on the Hema-Tek-2000 automatic slide stainer, using Wright-Giemsa stain and differential cell counts carried out to differentiate eosinophils, neutrophils and lymphomononuclear cells (including monocytes, macrophages and lymphocytes). Typically, 200 cells are counted per slide and each cell type expressed as a percentage of the total count. BALF total white cell count is measured using a Sysmex (Sysmex UK, Milton Keynes). Example 4 Evaluation of lung function in anaesthetised guinea pigs.

Male Dunkin-Hartley guinea pigs (300-60Og) were weighed and dosed with vehicle (0.05M phosphate, 0.1% Tween 80, 0.6% saline, pH 6) or compound via the intratracheal route under recoverable gaseous anaesthesia (5% halothane in oxygen). Animals were dosed with compound or vehicle two hours prior to the administration of histamine or methacholine.

Guinea pigs were anaesthetised with pentobarbitone (1 mL/kg of 60 mg/mL solution i.p.) approximately 30 minutes prior to the first bronchoconstrictor administration. The trachea was cannulated and the animal ventilated using a constant volume respiratory pump

(Harvard Rodent Ventilator model 683) at a rate of 60 breath/min and a tidal volume of 5 ml/kg. A jugular vein was cannulated for the administration of histamine, methacholine or maintenance anaesthetic (0.1 mL of pentobarbitone solution, 60 mg/mL, as required).

The animals were transferred to a Flexivent System (SCIREQ, Montreal, Canada) in order to measure airway resistance. The animals were ventilated (quasi-sinusoidal ventilation pattern) at 60 breaths/min at a tidal volume of 5 mL/kg. A positive end expiratory pressure of 2-3 CmH₂O was applied. Respiratory resistance was measured using the Flexivent "snapshot" facility (1 second duration, 1 Hz frequency). Once stable baseline resistance value had been obtained the animals were given histamine or methacholine in ascending doses (0.5, 1, 2, 3 and 5μg/kg, Lv) at approximately 4-minute intervals via the jugular catheter. After each administration of bronchoconstrictor the peak resistance value was recorded. Guinea pigs were euthanised with approximately 1.OmL pentobarbitone sodium (Euthatal) intravenously after the completion of the lung function measurements. Percentage bronchoprotection produced by a compound was calculated at each dose of brochoconstrictor as follows:

%changeR_veh - %changeR_cmpιl

% bronchoprotection = ^■

%changeR_vell

Where % change R_veh is the mean of the maximum percentage change in airway resistance in the vehicle treated group. The results reported were measured after 5μg/kg histamine or methacholine and were expressed as percentage bronchoprotection (mean ± s.e.mean). Compound AA and roflumilast combination:

Guinea pigs dosed with vehicle, 0.42 and 14 μg/kg Compound AA, lmg/kg roflumilast or a combination of 0.42 μg/kg Compound AA and lmg/kg roflumilast via the intratracheal route. Administration of increasing intravenous doses of histamine (0.5, 1, 2, 3 and 5 μg/kg) evoked dose-related bronchoconstriction in the vehicle treated animals ranging from 28±2.9% at 0.5 μg/kg to 1300±131% at 5 μg/kg two hours after vehicle administration (n=9). Intratracheal administration of roflumilast at lmg/kg produced 0% inhibition of histamine-induced bronchoconstriction (1330±359% increase in bronchoconstriction; n=7). Intratracheal administration of compound AA (0.42 and 14μg/kg) produced 33 and 79% inhibition of histamine-induced bronchoconstriction (866±173 and 271±116% increase in bronchoconstriction, respectively; n=8 and 6, respectively). The combination of roflumilast (lmg/kg) and compound A (0.42 μg/kg) produced 43% inhibition of histamine-induced bronchoconstriction (744±114% increase in bronchoconstriction; n=7) (Figure 1).

Compound AA and tiotropium bromide combination:

Guinea pigs dosed with vehicle, 0.42 and 14 μg/kg Compound AA, 0.1 μg/kg tiotropium bromide or a combination of 0.42 μg/kg Compound AA and 0.1 μg/kg tiotropium bromide via the intratracheal route. Administration of increasing intravenous doses of methacholine (0.5, 1, 2, 3 and 5 μg/kg) evoked dose-related bronchoconstriction in the vehicle treated animals ranging from 10±2.9% at 0.5 μg/kg to 1910±194% at 5 μg/kg two hours after vehicle administration (n=9). Intratracheal administration of tiotropium bromide at 0.1 μg/kg produced 28% inhibition of methacholine-induced bronchoconstriction (1360±318% increase in resistance, n = 8). Intratracheal administration of compound AA (0.42 and 14 μg/kg) produced 18 and 70% inhibition of methacholine-induced bronchoconstriction (1571±282 and 565±127% increase in resistance, respectively; n=7 and 4, respectively). The combination of tiotropium bromide (0.1 μg/kg) and compound AA (0.42μg/kg) produced 73% inhibition of methacholine- induced bronchoconstriction (515±109% increase in resistance; n=8) (Figure 2). Example 5

Evaluation of Compounds on Antigen induced Eosinophilia in Ovalbumin Sensitised Brown Norway Rats.

On day 0 of the study Brown Norway rats are given a subcutaneous injection of 500 μg ovalbumin adsorbed onto 100 mg aluminium hydroxide in 0.4 mL saline in two distinct sites, approximately 0.2 mL per site. Day 14 and 15 following sensitisation the rats are challenged with aerosolised ovalbumin for 15 minutes. The rats are placed in groups of 10 in an acrylic box (internal dimensions 320mm wide x 320mm deep x 195 mm high, 2OL volume). 8mL of 10 mg/mL ovalbumin in 0.9% saline, or 0.9% saline alone, is placed in each of two jet nebulizers (Sidestream®, Profile Respiratory Systems Ltd.). Compressed air at 6 L/min is passed through each nebulizer and the output of the nebulizers is passed into the box containing the rats.

Rats are dosed via the appropriate route with vehicle, standard compound or test compound at various time points before and after challenge depending upon the experimental protocol. Rats are euthanised with 0.5 mL pentobarbitone sodium (Euthatal) intraperitoneally at various times after challenge. A tracheotomy is performed and the trachea cannulated. The airway is then lavaged using 3 mL sterile PBS at room temperature. The PBS is left in the airway for 10 seconds before being removed. The PBS containing cells is placed into a 15 mL centrifuge tube on ice. This process is repeated three times. The final volume recovered is recorded. An aliquot of BAL fluid is removed and counted using a Sysmex (Sysmex UK, Milton Keynes).

Cytospin slides are prepared by adding a 100 μl aliquot of BAL fluid into cytospin funnels in a Shandon Cytospin 3 operated at 700 rpm for 5 min. Slides are stained on the Hema- Tek-2000 automatic slide stainer, using Wright-Giemsa stain and typically, 200 cells are counted under a microscope. Cells are classified as eosinophils, neutrophils and mononuclear cells. Mononuclear cells included monocytes, macrophages and lymphocytes.

Example 6

Evaluation of Compounds on Antigen induced eosinophilia in ovalbumin sensitised mice. 20-25g male BALB/c mice are sensitized to ovalbumin by i.p administration of 100 μg of grade V ovalbumin (Sigma) adsorbed onto lmg of ahuninium hydroxide gel mixture (Fisher Scientific UK) in 0.3 ml saline. Groups of mice are pre-dosed with compound if required, a minimum of two weeks after sensitization. They are then dosed daily for 1-8 days as study protocol specified, with test compound or 0.25 ml vehicle.

Each day of the 1-8 days, 1 hour after dosing, the mice are placed in perspex chambers (20x11x1 lcm, 10 mice max./chamber) and administered an aerosol challenge of 20mg ml^"1 ovalbumin for 36 min (8 ml for 18 min followed by another 8 ml for 18 min). Aerosol delivery is achieved using a DeVilbiss jet nebulizer with a flow rate of 61 min^"1. 24h after the last dose the mice are killed with euthatal 0.2 ml i.p. and blood samples are taken (in EDTA tubes) for differential cell count analysis, the trachea is cannulated using a pink luer mount Portex cannula cut to lcm and the lungs are lavaged using 3 washes of ImI of Isoton IL. For cytospins, lOOμl of the BALF is added to a cytospin funnel and spun, using a ThermoShandon Cytospin model 3 or 4, at 700 rpm for 5 min. Cells on the slide are stained on the Hema-Tek-2000 automatic slide stainer, using Wright-Giemsa stain and differential cell counts carried out to differentiate eosinophils, neutrophils and lymphomononuclear cells (including monocytes, macrophages and lymphocytes). Typically, 200 cells are counted per slide and each cell type expressed as a percentage of the total count. BALF total white cell count is measured using a Sysmex (Sysmex UK, Milton Keynes).

Example 7

Evaluation on the effect of compound on lung function and BAL-neutrophilia following acute smoke exposure in the mouse

BALB/c or C57BL6/J mice undergo whole body exposure to main stream smoke (50 min/12 cigarettes) and fresh air once or twice a day for 1-9 days. Mice are dosed via the appropriate route with vehicle, standard compound or test compound at various time points before and after challenge depending upon the experimental protocol. On the final day of the experiment, mice are either killed with euthatal 0.2 ml i.p. and broncho-aveolar lavage fluid obtained for analysis of white blood cell infiltration (as described above) or lung function is assessed using a Flexivent System (SCIREQ, Montreal, Canada). Alternatively lung mechanics are measured using a forced manoeuvres system (EMMS).

Mice are anaesthetised with pentobarbitone (1/lOdilution at a dose volume of 1 mL/kg intraperitoneally). The trachea is cannulated and the animal transferred to the Flexivent System where they are ventilated (quasi-sinusoidal ventilation pattern) at a rate of 150 breath/min and a tidal volume of 10 ml/kg in order to measure airways resistance. Respiratory resistance is measured using the Flexivent "snapshot" facility (1 second duration, 1 Hz frequency). Mice are euthanised with approximately 0.5mL pentobarbitone sodium (Euthatal) intravenously after the completion of the lung function measurements.

Example 8

Evaluation of bronchodilator activity in the guinea pig isolated tracheal ring preparation: onset measurements. Guinea pigs (300-500g) were killed by cervical dislocation and the trachea was isolated. The trachea was cut into segments 2-3 cartilage rings in width and suspended in 10ml organ baths in modified Krebs' solution (mM; NaCl, 90; NaHCO₃, 45; KCl, 5; MgSO₄JH₂O, 0.5; Na₂HPO₄.2H₂O, 1; CaCl₂, 2.25; glucose, 10; pH 7.4, gassed with 5% CO₂, 95% O₂ at 37°C). The tracheal rings were attached to an isometric force transducer for the measurement of isometric tension. The tissues were washed and a force of Ig was applied to each tissue. The rings were contracted with methacholine (1 μM). Once the contraction had reached a plateau, vehicle, compound A (6.3nM), roflumilast (lμM) or a combination of compound A (6.3nM) and roflumilast (lμM) was added and the tissue left until the response had reached a plateau. Data were collected using the Chart 4 software (ADInstruments, Charlgrove, UK). The time to 90% of the maximum effect of the bronchodilator (onset time) was measured and expressed in min (mean ± s.e.mean).

The onset time for compound AA at 6.3nM was 12±1.1 min, in the presensce of roflumilast (lμM), the onset time for Compound AA (6.3nM) was 6.1±1.7 min and the onset time for roflumilast (1 μM) was 28±8.7 min.

Example 9 Evaluation of bronchodilator activity in the guinea pig isolated tracheal ring preparation: apparent potency measurements.

Guinea-pigs (300-50Og) were killed by cervical dislocation and the trachea was isolated. The trachea was cut into four ring segments (2-3 cartilage rings in width) and suspended in 10ml organ baths in modified Krebs' solution (niM; NaCl, 90; NaHCO₃, 45; KCl, 5; MgSO₄JH₂O, 0.5; Na₂HPO₄.2H₂O, 1; CaCl₂, 2.25; glucose, 10; pH 7.4, gassed with 5% CO₂, 95% O₂ at 37°C). The tracheal rings were attached to an isometric force transducer for the measurement of isometric tension. The tissues were washed and a force of Ig was applied to each tissue. The rings were incubated with either vehicle or rofiumilast (1OnM- 1 μM) for 20 minutes before a contraction was induced with methacholine (1 μM). Following the plateau of the methacholine constriction, a cumulative concentration- response curve to compound AA was constructed (InM - 10 μM). Data were collected using the Chart 4 software (ADInstruments, Charlgrove, UK) and the apparent pD₂ values were calculated using a 4 parameter logistic in a non-linear curve fitting routine using Prism 4 (Graphpad Software Inc, San Diego, USA), expressed as mean ± s.e.mean.

The potency of compound AA in the presence of vehicle was 8.2±0.10 (n=5). In the presensce of 1OnM , 10OnM and lμM rofiumilast the apparent potency of compound AA was 8.3±0.31 (n=3), 8.5±0.27 (n=3) and 8.8±0.10 (n = 5), respectively.

Claims

1. A pharmaceutical product comprising, in combination, a first active ingredient which is iV-[2-(Diethylamino)ethyl]-N-(2-{[2-(4-hydroxy-2-oxo-2,3-dihydro-l,3- benzothiazol-7-yl)ethyl] amino } ethyl)-3 - [2-(3 -chlorophenyl)ethoxy]propanamide or a salt thereof, and a second active ingredient selected from: a non-steroidal Glucocorticoid Receptor (GR Receptor) Agonist; an antioxidant; a CCRl antagonist; a chemokine antagonist (not CCRl); a corticosteroid; a CRTh2 antagonist; a DPI antagonist; an Histone Deacetylase Inducer; an IKK2 inhibitor; a COX inhibitor; a lipoxygenase inhibitor; a leukotriene receptor antagonist; an MPO inhibitor; a muscarinic antagonist which is Aclidinium bromide, Glycopyrrolate, Oxitropium bromide, Pirenzepine, telenzepine, Tiotropium bromide, 3(R)-(2-hydroxy-2,2- dithien-2-ylacetoxy)-l-(3-phenoxypropyl)-l-azoniabicyclo[2.2.2]octane bromide,

3 (R)- 1 -phenethyl-3 -(9H-xanthene-9-carbonyloxy)- 1 -azoniabicyclo [2.2.2]octane bromide or (3R)-3-[(2S)-2-cyclopentyl-2-hydroxy-2-thien-2-ylacetoxy]-l-(2- phenoxyethyl)-l-azoniabicyclo[2.2.2]actane bromide; a p38 inhibitor; a PDE inhibitor; a PPARγ agonist; a protease inhibitor; a Statin; a thromboxane antagonist; a vasodilator; or, an ENAC blocker (Epithelial Sodium-channel blocker).

2. A kit comprising: a preparation of a first active ingredient which is N-[2-(Diethylamino)ethyl]-iV-(2-

5 {[2-(4-hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol-7-yl)ethyl]amino}ethyl)-3-[2-

(3-chlorophenyl)ethoxy]propanamide or a salt thereof, a preparation of a second active ingredient which is selected from: a non-steroidal Glucocorticoid Receptor (GR Receptor) Agonist; an antioxidant; a CCRl antagonist; a chemokine antagonist (not CCRl); a corticosteroid; a CRTh2 i₀ antagonist; a DPI antagonist; an Histone Deacetylase Inducer; an IKK2 inhibitor; a

COX inhibitor; a lipoxygenase inhibitor; a leukotriene receptor antagonist; an MPO inhibitor; a muscarinic antagonist which is Aclidinium bromide, Glycopyrrolate, Oxitropium bromide, Pirenzepine, telenzepine, Tiotropium bromide, 3(R)-(2- hydroxy-2,2-dithien-2-ylacetoxy)- 1 -(3 -phenoxypropyl)- 1 - is azoniabicyclo[2.2.2]octane bromide, 3(R)-l-phenethyl-3-(9H-xanthene-9- carbonyloxy)-l-azoniabicyclo[2.2.2]octane bromide or (3R)-3-[(2S)-2-cyclopentyl- 2-hydroxy-2-thien-2-ylacetoxy]-l-(2-phenoxyethyl)-l-azoniabicyclo[2.2.2]actane bromide; a p38 inhibitor; a PDE inhibitor; a PPARγ agonist; a protease inhibitor; a Statin; a thromboxane antagonist; a vasodilator; or, an ENAC blocker (Epithelial

₂₀ Sodium-channel blocker), and optionally, instructions for the simultaneous, sequential or separate administration of the preparations to a patient in need thereof.

3. A pharmaceutical composition comprising, in admixture:

₂₅ a first active ingredient which is N-[2-(Diethylamino)ethyl]-JV-(2-{ [2-(4-hydroxy-2- oxo-2,3 -dihydro- 1 ,3 -benzothiazol-7-yl)ethyl] amino } ethyl)-3 -[2-(3 - chlorophenyl)ethoxy]propanamide or a salt thereof; a second active ingredient which is selected from: a non-steroidal Glucocorticoid Receptor (GR Receptor) Agonist; an antioxidant; a CCRl antagonist; a chemokine

30 antagonist (not CCRl); a corticosteroid; a CRTh2 antagonist; a DPI antagonist; an

Histone Deacetylase Inducer; an IKK2 inhibitor; a COX inhibitor; a lipoxygenase inhibitor; a leukotriene receptor antagonist; an MPO inhibitor; a muscarinic antagonist which is Aclidinium bromide, Glycopyrrolate, Oxitropium bromide, Pirenzepine, telenzepine, Tiotropium bromide, 3(R)-(2-hydroxy-2,2-dithien-2- ylacetoxy)-l-(3-phenoxypropyl)-l-azoniabicyclo[2.2.2]octane bromide, 3(R)-I- phenethyl-3-(9H-xanthene-9-carbonyloxy)-l-azoniabicyclo[2.2.2]octane bromide

5 or (3R)-3-[(2S)-2-cyclopentyl-2-hydroxy-2-thien-2-ylacetoxy]-l-(2-phenoxyethyl)- l-azoniabicyclo[2.2.2]actane bromide; a p38 inhibitor; a PDE inhibitor; a PPARγ agonist; a protease inhibitor; a Statin; a thromboxane antagonist; a vasodilator; or, an ENAC blocker (Epithelial Sodium- channel blocker); and, io a pharmaceutically acceptable adjuvant, diluent or carrier.

4. A method of treating a respiratory disease, which method comprises simultaneously, sequentially or separately administering:

(a) a therapeutically effective dose of a first active ingredient which is JV-[2- i₅ (Diethylamino)ethyl]-iV-(2- { [2-(4-hydroxy-2-oxo-2,3-dihydro- 1 ,3-benzothiazol-7- yl)ethyl]amino}ethyl)-3-[2-(3-chlorophenyl)ethoxy]propanamide or a salt thereof; and,

(b) a therapeutically effective dose of a second active ingredient which is selected from: a non-steroidal Glucocorticoid Receptor (GR Receptor) Agonist; an

20 antioxidant; a CCRl antagonist; a chemokine antagonist (not CCRl); a corticosteroid; a CRTh2 antagonist; a DPI antagonist; an Histone Deacetylase Inducer; an IKK2 inhibitor; a COX inhibitor; a lipoxygenase inhibitor; a leukotriene receptor antagonist; an MPO inhibitor; a muscarinic antagonist which is Aclidinium bromide, Glycopyrrolate, Oxitropium bromide, Pirenzepine,

2₅ telenzepine, Tiotropium bromide, 3 (R)-(2-hydroxy-2,2-dithien-2-ylacetoxy)- 1 -(3 - phenoxypropyl)-l-azoniabicyclo[2.2.2]octane bromide, 3(R)-l-phenethyl-3-(9H- xanthene-9-carbonyloxy)-l-azoniabicyclo[2.2.2]octane bromide or (3R)-3-[(2S)-2- cyclopentyl-2-hydroxy-2-thien-2-ylacetoxy]- 1 -(2-phenoxyethyl)- 1 - azoniabicyclo[2.2.2]actane bromide;

30 a p38 inhibitor; a PDE inhibitor; a PPARγ agonist; a protease inhibitor; a Statin; a thromboxane antagonist; a vasodilator; or, an ENAC blocker (Epithelial Sodium- channel blocker); to a patient in need thereof.

5. A pharmaceutical product, kit or composition or method as claimed in claim 1, 2, 3 or 4 wherein the second active ingredient selected from:

5 a non-steroidal Glucocorticoid Receptor (GR Receptor) Agonist; a CCRl antagonist; a chemokine antagonist (not CCRl); a corticosteroid; an IKK2 inhibitor; io a muscarinic antagonist which is Aclidinium bromide, Glycopyrrolate, Oxitropium bromide, Pirenzepine, telenzepine, Tiotropium bromide, 3(R)-(2-hydroxy-2,2- dithien-2-ylacetoxy)-l-(3-phenoxypropyl)-l-azoniabicyclo[2.2.2]octane bromide,

3 (R)- 1 -phenethyl-3-(9H-xanthene-9-carbonyloxy)- 1 -azoniabicyclo[2.2.2]octane bromide or (3R)-3-[(2S)-2-cyclopentyl-2-hydroxy-2-thien-2-ylacetoxy]-l-(2- i₅ phenoxyethyl)-l-azoniabicyclo[2.2.2]actane bromide; a p38 inhibitor; or, a PDE inhibitor.

6. A pharmaceutical product, kit or composition or method as claimed in claim 1, 2, 3, 20 4 or 5 wherein the first active ingredient is in the form of a salt which is a hydrochloride, hydrobromide, trifluoroacetate, sulphate, phosphate, acetate, fumarate, maleate, tartrate, lactate, citrate, pyruvate, succinate, oxalate, methanesulphonate, /j-toluenesulphonate, bisulphate, benzenesulphonate, ethanesulphonate, malonate, xinafoate, ascorbate, oleate, nicotinate, saccharinate, 2₅ adipate, formate, glycolate, L-lactate, D-lactate, aspartate, malate, L-tartrate, D- tartrate, stearate, 2-furoate, 3-furoate, napadisylate (naphthalene- 1,5-disulfonate or naphthalene- 1 -(sulfonic acid)-5 -sulfonate), edisylate (ethane- 1 ,2-disulfonate or ethane- 1 -(sulfonic acid)-2-sulfonate), isethionate (2-hydroxyethylsulfonate), 2- mesitylenesulphonate or 2-naphthalenesulphonate.

30

7. A pharmaceutical product, kit or composition or method as claimed in any one of the preceding claims wherein the first active ingredient is in the form of a salt which is a dihydrobromide.

8. A pharmaceutical product, kit or composition or method as claimed in any one of the preceding claims wherein the the second active ingredient is a muscarinic antagonist which is a muscarinic antagonist which is Aclidinium bromide, Glycopyrrolate, Oxitropium bromide, Pirenzepine, telenzepine, Tiotropium bromide, 3 (R)-(2-hydroxy-2,2-dithien-2-ylacetoxy)- 1 -(3 -phenoxypropyl)- 1 - azoniabicyclo[2.2.2]octane bromide, 3(R)-l-phenethyl-3-(9H-xanthene-9- carbonyloxy)-l-azoniabicyclo[2.2.2]octane bromide or (3R)-3-[(2S)-2-cyclopentyl-

2-hydroxy-2-thien-2-ylacetoxy]-l-(2-phenoxyethyl)-l-azoniabicyclo[2.2.2]actane bromide.

9. A pharmaceutical product, kit or composition or method as claimed in any one of the preceding claims wherein the second active ingredient is Tiotropium bromide.

10. A pharmaceutical product, kit or composition or method as claimed in any one of claims 1 to 7 wherein the second active ingredient is a CCRl antagonist.

11. A pharmaceutical product, kit or composition or method as claimed in any one of claims 1 to 7 wherein the second active ingredient is a corticosteroid.

12. A pharmaceutical product, kit or composition or method as claimed in any one of claims 1 to 7 wherein the second active ingredient is a PDE4 inhibitor.

13. Use of a pharmaceutical product, kit or composition as claimed in claim 1-3 or 5-12 in therapy.

14. Use of a pharmaceutical product, kit or composition as claimed in claim 1-3 or 5-12 in the manufacture of a medicament for the treatment of a respiratory disease.

15. Use of a pharmaceutical product, kit or composition as claimed in claim 1-3 or 5-12 for the treatment of a respiratory disease.

16. Use according to claim 14 or 15, wherein the respiratory disease is chronic obstructive pulmonary disease, asthma, rhinitis, emphysema or bronchitis.