Currently available LABAs and LAMAs as monotherapy.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 179 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 252 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"6895",leadTitle:null,fullTitle:"Moths - Pests of Potato, Maize and Sugar Beet",title:"Moths",subtitle:"Pests of Potato, Maize and Sugar Beet",reviewType:"peer-reviewed",abstract:"This book contains four chapters. 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Although considered both preventable and treatable [1], COPD remains a leading cause of morbidity and mortality [2, 3], affecting an estimated 384 million people worldwide [4]. The COPD prevalence is projected to increase in the coming decades [5], as well as its position among the leading causes of mortality [4].
\nActive or passive cigarette smoking is the most commonly encountered risk factor for COPD across the world [1]; however other factors may play a role in the disease pathogenesis, such as genetic factors [6, 7], exposure to indoor and outdoor air pollutants [8, 9, 10, 11], exposure to occupational dusts, chemical agents or fumes [12], infections (HIV, tuberculosis) [13, 14], and socioeconomic status [15].
\nThe normal lung response to the inhalation of noxious factors is an inflammatory reaction of the airways. In patients who develop COPD, the excessive inflammatory response is further enhanced by the oxidative stress and an imbalance of the protease-antiprotease system, leading to the destruction of the lung parenchyma and disruption of normal repair and defense mechanisms. Emphysema and small airway fibrosis are the consequences of these processes, which translate into gas trapping and chronic airflow limitation [1].
\nBy definition, COPD is a chronic condition, and the major symptoms exhibited by the patients suffering from this disease, dyspnea, cough, and sputum production, are usually persistent and/or progressive and have a considerable negative effect on the patient’s quality of life. The Global Burden of Disease Study highlighted that COPD is a major contributor to disability and mortality around the world, by ranking COPD as the fifth leading cause of disability-adjusted life years (DALYs) lost in 2013 [16].
\nThe natural course of the disease is grafted by acute episodes of worsening of symptoms triggered by infectious agents, air pollution, and other factors. These events are referred to as “exacerbations” and usually require a change in medication and/or hospitalization. Exacerbations are associated with accelerated lung function decline, reduced quality of life, and increased mortality [17] and, not surprisingly, have been surnamed as “chest attacks” or “strokes of the lung” [18, 19].
\nThe main goals for the management of stable COPD are improvement in quality of life by relieving symptoms and increasing exercise tolerance and reduction of mortality risk by preventing exacerbations and disease progression [1].
\nSeveral inhaled, oral, and systemically administered drugs improve lung function, decrease the frequency and severity of COPD exacerbations, and improve patients’ quality of life [20].
\nNon-pharmacological therapies in COPD, including smoking cessation strategies, pulmonary rehabilitation, vaccinations, surgical or bronchoscopic interventions, and noninvasive ventilation have their established role in the management of the disease; however they are not discussed here, as the focus of this chapter is on the pharmacological treatment.
\nBack in 2001 when the first edition of the GOLD document was released [21], the pharmacological arsenal for the treatment of COPD was rather limited, comprising of short-acting beta2-agonists and anticholinergics, long-acting beta2-agonists, theophyllines, and mucoactive agents. Inhaled corticosteroids, although available as single medication, were never widely recommended for the treatment of COPD in monotherapy and have no current authorization for use outside fixed-dose combinations.
\nNowadays, there is a broader range of molecules recommended for the treatment of stable COPD that can be classified in the following classes of pharmacological agents:
Beta2-agonists: short-acting (SABA) and long-acting (LABA)
Anticholinergics: short-acting (SAMA) and long-acting (LAMA)
Fixed-dose combinations: SABA/SAMA, LABA/ICS, LABA/LAMA, LABA/LAMA/ICS
Methylxanthines
Phosphodiesterase-4 (PDE4) inhibitors
Mucolytics
Antibiotics
Additionally, a new acquisition in the bronchodilator portfolio could be the potential use of dual agents or bifunctional muscarinic antagonists and beta2-agonists (MABAs), which combine both antimuscarinic and adrenergic properties in a single molecule [22]. Some of these molecules are already in clinical trials, but a major caveat is the difficulty to balance the antimuscarinic and adrenergic activities, without expressing a tendency toward one of them [23].
\nEfforts have been made for the discovery of new pharmacological agents, either belonging to the mentioned classes or addressing new therapeutic targets: new corticosteroids, novel classes of bronchodilators, kinase inhibitors, mediator antagonists (including biological therapies, such as cytokine inhibitors), antioxidants, etc. Unfortunately, many of these molecules never made it to the market or were not granted approval for COPD due to safety, efficacy, or delivery issues; several others are still in the development process [23].
\nCurrently available pharmacological agents and other therapies are mainly used as pathogenic or symptomatic treatment.
\nChronic airflow limitation is a central characteristic of COPD and is the result of the combination in varying degrees of several pathological processes such as narrowing of the airways, mucus hypersecretion, and loss of small conducting airways [24]. The consequences of these anatomic changes are expiratory airflow limitation, air trapping, and ventilation-perfusion mismatch [22, 25]. Additionally, the loss of elastic recoil and hyperinflation adversely affect thoracic and diaphragmatic mechanics, increasing the work of breathing and ultimately leading to dynamic hyperinflation [26]. Hyperinflation is an independent predictor of mortality in COPD [27].
\nThe clinical expression of airflow limitation is chronic, progressive dyspnea, which typically worsens with physical exercise. Chronic cough with or without sputum production is usually a reflection of the ongoing inflammatory process in the airways of COPD patients. However, there is no linear correlation between the severity of the airflow limitation and the level of symptoms. Some patients may have little subjective complaints, although the lung function testing reveals various degrees of airflow limitation, while other patients may have significant complaints, with little or no evidence of airflow obstruction [28]. In some cases, the symptoms may precede the development of airflow limitation by many years [1].
\nTreatment with inhaled bronchodilators can reduce hyperinflation, improve dyspnea, and increase exercise tolerance [29], and therefore, bronchodilators are considered as a cornerstone in the management of stable COPD [30].
\nWhile short-acting bronchodilators are an option for patients with occasional dyspnea at low risk of exacerbations, the majority of patients have breathlessness leading to exercise limitation at the time of diagnosis and may require more intensive treatment than short-acting bronchodilators alone [30]. For these patients, whether or not they are also at higher risk of exacerbations, long-acting bronchodilators (as monotherapy or in combination) are recommended as a preferred treatment choice in the GOLD strategy report [1].
\nAirway tone is controlled by both the sympathetic and parasympathetic nervous systems. These mechanisms interact and may potentiate each other and are employed alone or in combination therapeutically. Relaxation of airway smooth muscle is caused by blockade of acetylcholine activity at the receptor (muscarinic antagonist) or stimulation of the G protein-coupled receptor (beta-agonist) [31].
\nAnticholinergic drugs in the form of smoked alkaloids were among the first effective treatments for asthma [32]. In the mid-twentieth century, parenteral muscarinic antagonists and beta-agonists were used for acute attacks of asthma [33]. The major disadvantages of the systemic delivery were the side effects and a short duration of benefit. As such, subsequent work has both optimized the receptor specificity and the duration of action [22].
\nBeta-agonists were in use in Chinese medicine for millennia in the form of ephedra. Developments in the mid-twentieth century yielded compounds that specifically target the beta2-adrenergic receptor, reducing the side effects from beta1-agonists [31].
\nSince the approval by the US Food and Drug Administration (FDA) in 2004 of the first LAMA, tiotropium, long-acting bronchodilators have begun to play a central role in the management of stable COPD. Currently available molecules for inhalation delivery are summarized in Table 1.
\n\n | Delivery type | \nDuration of action (h) | \n
---|---|---|
Long-acting beta2-agonists (LABA) | \n||
Arformoterol | \nNebulized | \n12 | \n
Formoterol | \nDPI | \n12 | \n
Indacaterol | \nDPI | \n24 | \n
Olodaterol | \nSMI | \n24 | \n
Salmeterol | \nMDI, DPI | \n12 | \n
Long-acting anticholinergics (LAMA) | \n||
Aclidinium bromide | \nDPI, MDI | \n12 | \n
Glycopyrronium bromide | \nDPI | \n12–24 | \n
Tiotropium | \nDPI, SMI | \n24 | \n
Umeclidinium | \nDPI | \n24 | \n
Currently available LABAs and LAMAs as monotherapy.
DPI = dry powder inhaler; MDI = metered dose inhaler; SMI = soft mist inhaler.
The benefits of long-acting bronchodilator monotherapy have been well proven across a range of clinical studies [30] and include improvement of the airflow limitation [34, 35, 36, 37, 38, 39], dyspnea [34, 35, 39], physical activity/exercise capacity [29, 40, 41, 42], health status [34, 35, 37, 38, 39], and prevention of exacerbations [35, 39, 43, 44]; however, many patients remain symptomatic despite treatment [45].
\nDual bronchodilation improves lung function compared with a single bronchodilator [30]. Long-acting beta2-agonists and long-acting muscarinic antagonists act via different mechanisms; when used together in patients with COPD, they exert additional bronchodilating effects [46]. Multiple studies have assessed [30] and demonstrated that the use of LABA/LAMA dual bronchodilation results in additional improvements in lung function, exacerbation rates, health status, and other outcome measures when compared with monobronchodilation, while the safety profile of the dual bronchodilators was similar to that observed with placebo and individual monocomponents. Currently available LABA/LAMA combinations are listed in Table 2.
\n\n | Delivery type | \nDuration of action (h) | \n
---|---|---|
Fixed-dose combinations of LABA and LAMA (LABA/LAMA) | \n||
Formoterol/Aclidinium | \nDPI | \n12 | \n
Formoterol/Glycopyrronium | \nMDI | \n12 | \n
Indacaterol/Glycopyrronium | \nDPI | \n12–24 | \n
Olodaterol/Tiotropium | \nSMI | \n24 | \n
Vilanterol/Umeclidinium | \nDPI | \n24 | \n
Currently available fixed-dose combinations of LABA/LAMA.
DPI = dry powder inhaler; MDI = metered dose inhaler; SMI = soft mist inhaler.
According to current guidelines and strategy reports, long-acting bronchodilators in monotherapy are adequate options for the majority of COPD patients, regardless of the disease severity. However, in the GOLD report 2019 [1], the authors provide a clarification of the concept of “escalation” and “de-escalation” of the COPD therapy, which was introduced in a previous version. While “de-escalation” is mainly employed for the withdrawal of ICS due to lack of response or side effects, such as pneumonia, the “escalation” of treatment should be prompted by either inappropriate symptomatic response to the initial therapy or by the presence of exacerbations despite regular treatment and consists of adding a second class of bronchodilator and/or an ICS and/or other pharmacological agents (azithromycin, roflumilast) in order to ensure maximal symptom relief and to curb the risk of exacerbations.
\nThe choice of the bronchodilator treatment should take into account several factors, such as physiological impairment, symptom burden, and exacerbation risk, and should be individualized according to the drug safety profile, cost, and patients’ preference for device and medication [1, 20].
\nOne of the current controversies in COPD [20] is the following: what is best, a progressive escalation of bronchodilator therapy or “maximizing” bronchodilator therapy with dual bronchodilator therapy ab initio? The members of the GOLD Scientific Committee suggest that ensuring a maximal bronchodilation from the beginning could be a reasonable approach for both patients with high symptom burden and patients less severely affected. The latter may underreport their symptoms, masking an underlying resting and exercise lung hyperinflation, which is further linked to increased mortality and risk of severe exacerbations [20]. However, if a single agent is preferred, currently available evidence supports the use of a LAMA (tiotropium) since it improves lung function and health status even in patients with milder disease [47].
\nCOPD exacerbations represent acute worsening of symptoms requiring changes in medication and/or hospitalization [1]. Anthonisen and colleagues’ criteria [48] have been used for decades now in an attempt to standardize the evaluation of these events; however COPD exacerbations still have no universally established definition [49] and are subject to diagnostic uncertainty [50].
\nHistorically, the level of healthcare resource use (HCRU) required for the management of COPD exacerbations was used both to define and quantify the severity of the exacerbations, with moderate exacerbations requiring administration of oral steroids and/or antibiotics and severe exacerbations requiring hospitalization [49, 51, 52, 53]. However, healthcare use in COPD varies widely depending on access, leading to disparities across different healthcare systems [54]. Furthermore, in order to be treated, an acute event should be reported to healthcare professionals; hence unreported events may not be captured by HCRU definitions. In some reports, such events comprise up to two-thirds of exacerbations and can impair health-related quality of life [55, 56] and increase the risk of hospitalization [57].
\nAnother approach to define exacerbations is based on the systematic and standardized assessment of daily symptoms recorded using specific questionnaires (diaries) administered to the patients on paper or electronically. These questionnaires were developed with the ability to detect worsening of symptoms beyond a pre-specified threshold, based on patients’ reporting of their daily symptoms [58, 59]. Advantages of a standardized, validated assessment of COPD symptoms in exacerbation studies include uniform metrics, reduced recall bias, and the ability to fully characterize exacerbations of COPD, including the estimated 50–70% of events that are unreported [55, 56, 59]. Although attractive, this kind of approach is more difficult to implement outside the clinical trial setting, and the concordance with the HCRU-defined events is modest [54, 60].
\nCOPD exacerbations have a marked negative effect on both the patient and underlying disease processes [61] and can result in hospitalization and readmission, an increased risk of death [62], and a significant reduction in health status [55]. Exacerbations are also associated with long-term decline in lung function and a high socioeconomic cost [63, 64]. A history of frequent exacerbations is a good predictor for future exacerbation risk and defines the “frequent exacerbator” phenotype [65]. Thus, optimizing the prevention and management of COPD exacerbations are important clinical issues [61].
\nThe GOLD strategy report stratifies COPD patients based on the severity of their airflow limitation, symptom burden, and the risk of exacerbations; however the recommendations for the pharmacological treatment rely exclusively on the level of symptoms and exacerbation risk [1].
\nWhile the initial assessment of exacerbation risk may be biased by the patients’ ability to recall historical episodes of symptom worsening prior to being diagnosed with COPD, the reassessment of risk after initial pharmacological treatment should be able to identify patients requiring an escalation of treatment for a better prevention of future exacerbation episodes.
\nThe preferred treatment options for patients at high risk of exacerbation are a LAMA in monotherapy, a LABA/LAMA, or a LABA/ICS combination [1].
\nThere is evidence that both LABAs and LAMAs significantly improve the exacerbation rate versus placebo [66, 67, 68]; however, clinical trials have shown a greater effect on exacerbation rates for LAMA treatment (tiotropium) versus LABA treatment [69, 70].
\nThere is a strong evidence that treatment with fixed-dose combinations of LABA/LAMA improves lung function, symptoms, and health-related quality of life compared to placebo or its individual bronchodilator components [71, 72, 73]. The superiority of dual bronchodilation in the prevention of exacerbations compared to monocomponents was demonstrated for a LABA/LAMA combination [74], while another large study found that combining a LABA with a LAMA did not reduce exacerbation rate as much as expected compared to LAMA alone [75].
\nSimilarly, an ICS combined with a LABA is more effective than the individual components in improving lung function and health status and reducing exacerbations in patients with a history of exacerbations and moderate to very severe COPD [76, 77]. Currently available ICS/LABA combinations are listed in Table 3.
\n\n | Delivery type | \nDuration of action (h) | \n
---|---|---|
Fixed-dose combinations of LABA and ICS (LABA/ICS) | \n||
Formoterol/Beclometasone | \nMDI | \n12 | \n
Formoterol/Budesonide | \nMDI, DPI | \n12 | \n
Formoterol/Mometasone | \nMDI | \n12 | \n
Salmeterol/Fluticasone | \nMDI, DPI | \n12 | \n
Vilanterol/Fluticasone furoate | \nDPI | \n24 | \n
Currently available fixed-dose combinations of LABA/ICS.
DPI = dry powder inhaler; MDI = metered dose inhaler.
Furthermore, another study demonstrated the superiority of a LABA/LAMA combination versus an ICS/LABA combination in the prevention of exacerbations in patients with moderate to very severe COPD and a history of exacerbations, regardless of baseline blood eosinophils [78].
\nIn a recently published review, a group of experts critically evaluated mechanisms potentially responsible for the increased benefit of LABA/LAMA combinations over single long-acting bronchodilators or LABA/inhaled corticosteroids in decreasing exacerbation. These included effects on lung hyperinflation and mechanical stress, inflammation, excessive mucus production with impaired mucociliary clearance, and symptom severity [79].
\nAlthough triple therapy in separate inhalers is already in use for COPD patients for a couple of years now, fixed triple therapy combining an ICS, a LABA, and a LAMA in a single inhaler recently emerged on the market. Currently, there are only two products approved by the European Medicines Agency (EMA) for use in COPD, and a third one was recently approved in Japan (see Table 4) [80].
\n\n | Delivery type | \nDuration of action (h) | \n
---|---|---|
Fixed-dose combinations of LABA, LAMA and ICS (LABA/LAMA/ICS) | \n||
Formoterol/Glycopyrronium/Beclometasone | \nMDI | \n12 | \n
Vilanterol/Umeclidinium/Fluticasone furoate | \nDPI | \n24 | \n
Formoterol/Glycopyrronium/Budesonide | \nMDI | \n12 | \n
Currently available fixed-dose combinations of LABA/LAMA/ICS.
DPI = dry powder inhaler; MDI = metered dose inhaler.
Several recent studies have demonstrated that single-inhaler triple therapy is more effective in reducing the exacerbation than LAMA alone, a LABA/ICS, or a LABA/LAMA combination [81, 82, 83, 84].
\nThe GOLD algorithm for the escalation of treatment in patients with persistent risk of exacerbations despite regular treatment provides that patients taking a single bronchodilator should be switched to dual bronchodilation and then to triple therapy and/or additional therapies. Alternatively, some patients with high blood eosinophils may benefit from a LABA/ICS combination prior to receiving triple therapy [1].
\nThe use of ICS in COPD has become very controversial in the last years, owing on the one hand to the limited effect on lung function and on the other hand to potential side effects associated with long-term use at the higher doses recommended for the treatment of COPD. These include:
Risk of infections such as pneumonia [85], tuberculosis and non-tuberculous mycobacterial disease [86], and oropharyngeal candidiasis [87]
Skin lesions [88]
Diabetes onset and progression [89]
Increased risk of bone fractures [90]
Cataracts [91]
The use of ICS alone is discouraged in COPD [20]; however several studies have demonstrated a consistent effect on exacerbation reduction of LABA/ICS fixed-dose combinations versus individual monocomponents [76, 77, 87, 92, 93].
\nThe need for biomarkers accurately assessing disease activity and response to therapy in order to develop better COPD treatment is well acknowledged [94]. Peripheral blood eosinophil level has emerged in the recent years as a promising biomarker, showing capabilities to predict both the risk of exacerbation and the magnitude of response to ICS therapy [95, 96, 97]. Thus, several post hoc or pre-specified analyses of clinical trials have shown that blood eosinophil levels may indicate which patients can benefit from a reduction of exacerbations by the treatment with ICS-containing regimens [84, 96, 98]. Various cutoff points were proposed for the level of blood eosinophils in order to identify the patients who would benefit most from the ICS therapy. A recent pooled analysis (n = 4528) evidenced that a level of blood eosinophils >300/mmc3 suggests a beneficial role of ICS, while a low level of blood eosinophils (<100/mmc3) may be a negative predictor of the ICS effects. This was previously observed in other two post hoc analyses [99, 100] and was confirmed in a pre-specified analysis of another randomized clinical trial [101].
\nOther classes of pharmacological agents, such as PDE4-inhibitors (roflumilast) or antibiotics (azithromycin) administered orally on top of inhaled therapy, may bring an additional benefit in reducing exacerbations [102, 103]. The side effects, however, limit their use to selected patients only.
\nTwo large clinical trials have failed to demonstrate a positive effect of the active treatments (LABA/ICS, ICS alone, and LABA alone) versus placebo on the mortality risk [36, 104].
\nSmoking cessation, vaccinations, supplemental oxygen for hypoxemic patients, and lung volume reduction surgery in selected patients are the only therapies that have been proven to improve survival; smoking cessation also attenuates disease progression [20].
\nInhaled long-acting bronchodilator treatment plays a central role in the management of stable COPD. Anti-inflammatory treatment with inhaled corticosteroids in combination with a long-acting beta2 agonist or with dual bronchodilation (LABA and LAMA) as part of the triple therapy improves outcomes especially in patients with high blood eosinophil level.
\nDespite all the progress made in the recent years in the field of COPD, we are still lacking drugs that can effectively modify the course of the disease [23].
\nThe unmet needs in COPD warrant further research for the discovery of new biomarkers and effective therapeutic agents able to radically improve short-term and long-term outcomes in patients suffering of this disease.
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",metaTitle:"Open Access Publishing Fees",metaDescription:"Open Access Publishing Fees",metaKeywords:null,canonicalURL:"/page/OA-publishing-fees",contentRaw:'[{"type":"htmlEditorComponent","content":"As a gold Open Access publisher, an Open Access Publishing Fee is payable on acceptance following peer review of the manuscript. In return, we provide high quality publishing services and exclusive benefits for all contributors. IntechOpen is the trusted publishing partner of over 118,000 international scientists and researchers.
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\\n\\nChoosing to publish with IntechOpen ensures the following benefits:
\\n\\nBenefits of Publishing with IntechOpen
\\n\\nAs a gold Open Access publisher, an Open Access Publishing Fee is payable on acceptance following peer review of the manuscript. In return, we provide high quality publishing services and exclusive benefits for all contributors. IntechOpen is the trusted publishing partner of over 118,000 international scientists and researchers.
\n\nThe Open Access Publishing Fee (OAPF) is payable only after your full chapter, monograph or Compacts monograph is accepted for publication.
\n\nOAPF Publishing Options
\n\n*These prices do not include Value-Added Tax (VAT). Residents of European Union countries need to add VAT based on the specific rate in their country of residence. Institutions and companies registered as VAT taxable entities in their own EU member state will not pay VAT as long as provision of the VAT registration number is made during the application process. This is made possible by the EU reverse charge method.
\n\nServices included are:
\n\nSee our full list of services here.
\n\nWhat isn't covered by the Open Access Publishing Fee?
\n\nIf your manuscript:
\n\nYour Author Service Manager will inform you of any items not covered by the OAPF and provide exact information regarding those additional costs before proceeding.
\n\nOpen Access Funding
\n\nTo explore funding opportunities and learn more about how you can finance your IntechOpen publication, go to our Open Access Funding page. IntechOpen offers expert assistance to all of its Authors. We can support you in approaching funding bodies and institutions in relation to publishing fees by providing information about compliance with the Open Access policies of your funder or institution. We can also assist with communicating the benefits of Open Access in order to support and strengthen your funding request and provide personal guidance through your application process. You can contact us at oapf@intechopen.com for further details or assistance.
\n\nFor Authors who are still unable to obtain funding from their institutions or research funding bodies for individual projects, IntechOpen does offer the possibility of applying for a Waiver to offset some or all processing feed. Details regarding our Waiver Policy can be found here.
\n\nAdded Value of Publishing with IntechOpen
\n\nChoosing to publish with IntechOpen ensures the following benefits:
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