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Saturday, August 29, 2009

Early Treatment off COPD May Increase Life Expectancy

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reating chronic obstructive pulmonary disease (COPD) during early stages may slow the progression of the disease, and allow those who suffer from the illness to live longer and suffer less. New research on a promising  anti-inflammatory drug, as well as a study on an already well-known anticholinergic drug, offer renewed hope for those who have been diagnosed with COPD.

Now the fourth leading cause of death in the United States, COPD is a progressive disease that causes irreversible damage to the lungs and is most commonly caused by years of smoking. An estimated 24 million Americans suffer from COPD. Symptoms of the illness may include shortness of breath, a persistent cough, mucus production, wheezing, chest tightness, and tiredness.

In the first of three reports on COPD published in the August 29th issue of the journal The Lancet, patients who began early treatment with the inhaled drug Spiriva (tiotropium) experienced improved outcomes in comparison to patients who remained untreated. According to lead researcher Dr. Marc Decramer, a professor in the department of pathophysiology at University Hospital of the University of Leuven in Belgium, “If you treat moderate disease with these anticholinergic drugs, you get clear improvements in lung function, health-related quality of life, exacerbations and even, maybe, in mortality.” As for the improvement in mortality, Decramer said that although this was not found to be statistically significant, there was a trend observed. He also pointed out that the treatments “seem to reduce the rate at which the disease progresses.”

Decramer and colleagues monitored 2,376 early stage COPD patients who were randomly assigned to receive Spiriva or a placebo. After following the progress of the participants for four years, the researchers found the rate of decline in lung function to be 12 percent lower among the recipients of Spiriva compared to those who received the placebo. In addition, patients taking Spiriva had 18 percent less flare-ups of their COPD, leading to a reduction of 26 percent in hospitalizations due to flare-ups. Decramer explained that it is highly important that COPD be diagnosed in the early stages, and that aggressive treatment begins upon diagnosis to attain the best possible outcomes.

The remaining two reports in The Lancet established the benefits of the new anti-inflammatory drug called Daxas (roflumilast) in the treatment of COPD. The drug is still undergoing the approval process of the U.S. Food and Drug Administration (FDA).

In the first study, Dr. Leonardo Fabbri of the University of Modena in Italy and his team followed 3,091 patients who suffered from severe COPD after randomly assigning then to receive either Daxas or a placebo. After monitoring the patients for one year, findings revealed that those patients taking Daxas gained improved lung function and experienced 17 percent less flare-ups of their COPD than did patients taking the placebo. In their report, the researchers conclude, “These results suggest that different subsets of patients exist within the broad range of COPD, and that targeted specific therapies could improve disease management.”

Dr. Klaus F. Rabe, of Leiden University Medical Center in the Netherlands led the second study in which Daxas was used in addition to the standard COPD treatments with long-acting bronchodilators or anticholinergics. A total of 1,677 patients having moderate-to-severe COPD took either Daxas or a placebo for a 24-week period. Those patients who were randomly assigned to receive Daxas also received the bronchodilator Serevent (salmeterol) or Spiriva. The results showed that patients who took Daxas with either Serevent or Spiriva experienced a greater improvement in lung function than they would have by taking Serevent or Spiriva alone.

A decrease in respiratory symptoms was another benefit observed in patients who were treated for COPD with Daxas. However, in both trials, patients taking Daxas experience side effects including nausea, diarrhea and weight loss.

The researchers concluded, “Roflumilast improves lung function in patients with moderate-to-severe COPD who are already being treated with long-acting bronchodilators [or anticholinergic drugs], although with expected class-specific adverse events. Roflumilast could become an important, concomitant treatment for these patients.”
 

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