New Pharmacotherapeutic Approaches for COPD
New Pharmacotherapeutic Approaches for COPD
This review has highlighted some of the trends evident in the development of new drugs for COPD and the deployment of existing ones. Although this might feel confusing, some general conclusions appropriate to clinical practice can be tentatively drawn. These might be summarized as follows:
To flesh out these ideas even more studies will be needed and many are already underway. The REACT trial which will report in 2015 has already been mentioned. The SUMMIT study includes patients with moderately severe COPD and a history of cardiovascular disease will help us understand whether treatment with bronchodilators and/or ICSs modifies the risk of dying and disease progression in these patients. We are beginning to understand more about what different types of exacerbation mean and how treatment affects them. A range of potentially important pharmacological targets have been identified and are now under study in the hope of improving on the solid and significant advances already made in the drug treatment of COPD. However, it is important to realize that we already have good ways of helping our patients and our greatest challenge will be to organize what we do better to ensure an increased uptake of treatment that can improve the well-being of those affected by COPD.
Conclusion
This review has highlighted some of the trends evident in the development of new drugs for COPD and the deployment of existing ones. Although this might feel confusing, some general conclusions appropriate to clinical practice can be tentatively drawn. These might be summarized as follows:
Patients with more symptoms, worse lung function and frequent exacerbations, will need more treatment, which will probably include anti-inflammatory drugs.
Long-acting inhaled drugs, whatever the delivery device, are safe and effective with LAMAs generally performing better than LABAs as monotherapy.
Adding another bronchodilator improves lung function but, as yet, the clinical benefit has not been firmly established.
ICSs reduce exacerbations with little change in lung function and are likely to be more effective in patients with an eosinophil count more than 2% and or a history of asthma. Pneumonia occurs more often in patients receiving fluticasone-containing compounds, but the clinical impacts of these events are unclear.
Other treatments such as long-term inhaled antibiotics or oral PDEIV inhibitors may be considered in poorly controlled COPD, but further data about the benefits are needed.
The treatment of COPD can be changed depending on the degree to which the patient is clinically stable, and in these circumstances, less intensive treatment may be justified.
To flesh out these ideas even more studies will be needed and many are already underway. The REACT trial which will report in 2015 has already been mentioned. The SUMMIT study includes patients with moderately severe COPD and a history of cardiovascular disease will help us understand whether treatment with bronchodilators and/or ICSs modifies the risk of dying and disease progression in these patients. We are beginning to understand more about what different types of exacerbation mean and how treatment affects them. A range of potentially important pharmacological targets have been identified and are now under study in the hope of improving on the solid and significant advances already made in the drug treatment of COPD. However, it is important to realize that we already have good ways of helping our patients and our greatest challenge will be to organize what we do better to ensure an increased uptake of treatment that can improve the well-being of those affected by COPD.