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Issue 7, 2008
HOT TOPICS IN RESPIRATORY MEDICINE
Modifying the clinical course of COPD
| Publ. date: | 2008 |
| ISBN: | 978-88-89881-64-4 |
| ISSN: | 1973-9664 |
| E-ISSN: | 2036-0886 |
| DOI: | 10.4147/HTR-080700 |
Abstract
This issue in the series Hot Topics in Respiratory Medicine provides an updated overview of factors affecting the health status of patients with chronic obstructive pulmonary disease (COPD) and its global burden to society. It also highlights potential interventions of interest concerning public health and preventive medicine.
Professor Antonio Anzueto and Dr. Marc Miravitlles assess COPD by dividing the discussion into three sections. First, they highlight the great burden of COPD and its exacerbations in society and then follow this with a description of the natural history of the disease and the impact of exacerbations on the clinical course. Finally, they analyze the data regarding the therapeutic effect of tiotropium on the potential modification in the evolution of patients with COPD.
Tiotropium has demonstrated it can improve lung function, reduce the frequency of exacerbations, and improve health status in patients with COPD in any stage of the disease. Furthermore, the new studies reviewed in this issue, OPTIMAL (optimal therapy of chronic obstructive pulmonary disease to prevent exacerbations and improve quality of life: a randomised, double-blind, placebo-controlled trial) and INSPIRE (Investigating New Standards for Prophylaxis In Reducing Exacerbations), suggest that tiotropium may change the clinical course of COPD. No treatment has demonstrated an impact on the rate of decline of lung function in COPD. Results from multiple studies using inhaled corticosteroids have always been negative, and the search for an agent that could change the natural history of the disease has thus far been unsuccessful. UPLIFT (Understanding the Potential Long-term Impacts on Function with Tiotropium) is a large, prospective study analyzing the effect of tiotropium on the rate of decline of lung function in COPD. Results of this study will be available by the end of 2008 and will answer the question whether a long-acting bronchodilator can change the course of this disease. This issue of Hot Topics presents evidence that supports the design of the UPLIFT study and the results of previous trials that opened the door to hope in changing the natural history of COPD.
Table of contents
Foreword
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in developed countries. Furthermore, the number of individuals affected has grown in recent years. Mortality due to COPD has increased despite the campaigns against tobacco use, thus making COPD the only potentially preventable disease in which mortality is still on the rise.
To some extent, COPD can be considered an orphan disease. In fact, most (if not all) of the drugs used in the stable phase of the disease have been initially developed for treating asthma. However, the distinct characteristics of COPD require a specific treatment approach. In this respect, tiotropium bromide is the first drug specifically developed for treatment of COPD, taking into account the molecular characteristics and the pathogenesis of the disease. Tiotropium has demonstrated its efficacy in improving lung function and reducing exacerbations and hospital admissions and, as a consequence of this, has improved health status of patients with COPD. The clinical efficacy, together with its excellent safety profile and easy administration with one daily dose, makes tiotropium the first-line treatment of COPD in any stage of severity.
Development of safe and effective drugs for COPD is a call for action. This disease had been considered nonresponsive to treatment and, therefore, many physicians held a pessimistic view of treatment goals. Fortunately, there is now much more we can offer to our patients and it is our responsibility as treating physicians to provide patients who have COPD with the best treatment available. It is time to change the paradigm and consider COPD a treatable disease.
In this issue of Hot Topics in Respiratory Medicine, the main clinical results with tiotropium, both in clinical trials and in the real-life setting, will be reviewed. The reader will be pleased to find evidence supporting the inclusion of tiotropium in all guidelines of treatment of patients with COPD.
ARTICLES
Modifying the clinical course of COPD
Antonio Anzueto, Marc Miravitlles
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Editor-in-chief
Marc Miravitlles - MD
Over the last 15 years there has been a decrease in mortality due to preventable diseases, with the exception of chronic obstructive pulmonary disease (COPD), which is an example that highlights the r...
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