Effect of Pharmacotherapy on Rate of Decline of Lung Function in Chronic Obstructive Pulmonary Disease

Celli, Bartolomé R.; Thomas, Nicola; Anderson, Julie A.; Ferguson, Gary T.; Jenkins, Christine; Jones, Paul; Vestbo, Jørgen; Knobil, Katharine; Yates, Julie; Calverley, Peter M.A.

doi:10.1164/rccm.200712-1869oc

Cited by 701 publications

(534 citation statements)

References 40 publications

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“…In the TORCH study, the combination of ICS and LABA reduced the rate of decline in FEV 1 in patients with moderate-to-severe COPD by 16 ml/year compared to placebo. This improvement was also observed in the LABA-only and in the ICS-only group [152].…”

Section: Combination Of Ics With Labasupporting

confidence: 65%

“…However, in two subsequent meta-analyses published, one concluded that ICS reduced FEV 1 decline by a small statistical mean rate of 7.7 ml/year [150], while another meta-analysis showed a non-significant 5.0 ml/year reduction [151]. However, in the 3-year TORCH study, a multicentre double-blind placebo-controlled randomised clinical trial involving 6,112 patients with COPD (mean post-bronchodilator FEV1 of 44%), fluticasone showed a significant improvement in FEV 1 decline of −42 ml/year compared to placebo of −55 ml/year [152]. This effect was not significantly different from that of salmeterol or of the combination of salmeterol and fluticasone together.…”

Section: Effect Of Ics Alonementioning

confidence: 95%

See 1 more Smart Citation

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

123

106

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International audienceInhaled corticosteroid (ICS) therapy in combination with long-acting β-adrenergic agonists represents the most important treatment for chronic airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). ICS therapy forms the basis for treatment of asthma of all severities, improving asthma control, lung function and preventing exacerbations of disease. Use of ICS has also been established in the treatment of COPD, particularly symptomatic patients, who experience useful gains in quality of life, likely from an improvement in symptoms such as breathlessness and in reduction in exacerbations, and an attenuation of the yearly rate of deterioration in lung function. The addition of long-acting β-agonist (LABA) therapy with ICS increases the efficacy of ICS effects in moderate-to-severe asthma. Thus, a 800 μg daily dose of the ICS budesonide reduced severe exacerbation rates by 49% compared to a low dose of 200 μg daily, and addition of the LABA formoterol to budesonide (800 μg) led to a 63% reduction. In COPD, the effects of ICS are less prominent but there are beneficial effects on the decline in FEV and the rate of exacerbations. A reduction in the rate of decline in FEV of 16 ml/year with a 25% reduction in exacerbation rate has been reported with the salmeterol and fluticasone combination. A non-significant 17.5% reduction in all-cause mortality rate with ICS and LABA is reported. Chronic inflammation is a feature of both asthma and COPD, although there are site and characteristic differences. ICS targets this inflammation although this effect of ICS is less effective in patients with severe asthma and with COPD; however, addition of LABA may potentiate the anti-inflammatory effects of ICS. An important consideration is the presence of corticosteroid insensitivity in these patients. Currently available ICS have variably potent binding activities to specific glucocorticoid receptors, leading to inhibition of gene expression by either binding to DNA and inducing anti-inflammatory genes or by repressing the induction of pro-inflammatory mediators. Local side effects of ICS include oral candidiasis, hoarseness and dysphonia, while systemic side effects, such as easy bruising and reduction in growth velocity or bone mineral densitometry, are usually restricted to doses above maximally recommended doses. Use of LABA alone in patients with asthma increases the risk of asthma-related events including deaths, but this is less observed with the combination of ICS and LABA. Therefore, use of LABA alone is not recommended for asthma therapy. Future progress in ICS development will be characterised by the introduction of ICS with greater efficacy with a limited side-effect profile, and by longer-acting ICS that can be used in combination with once-daily LABAs. Other agents that could improve the efficacy of corticosteroids or reverse corticosteroid insensitivity may be added to ICS. ICS in combination with LABAs will continue to remain the main focus of treatment of airways diseases

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Section: Combination Of Ics With Labasupporting

confidence: 65%

Section: Effect Of Ics Alonementioning

confidence: 95%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

123

106

View full text Add to dashboard Cite

show abstract

“…Not fully, since treatment may reduce the number of exacerbations but not necessarily affect lung function decline in the same patient. In addition, even if this is the case in a subset of COPD patients, 7,8 it is not clear which characteristics predict this response. This also holds true for mortality as a future risk: here we have information that a composite measure such as the BODE index predicts mortality better than airflow obstruction alone and at the same time predicts future exacerbations.…”

Section: Exacerbations As An Example Of the Link Between Best Currentmentioning

confidence: 99%

“…PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org data support the efficacy of existing pharmacological treatments on prevention of exacerbations, 5,6 together with some effect on lung function decline 7,8 and improved survival, 9 many clinicians remain sceptical. Additionally, non-pharmacological treatment options in secondary care -including pulmonary rehabilitation, lung volume reduction surgery, oxygen therapy and influenza vaccination -have successfully improved well-being and/or the prognosis of COPD, but are often not considered.…”

mentioning

confidence: 93%

A new perspective on optimal care for patients with COPD

Postma

Anzueto²,

Calverley

et al. 2011

Primary Care Respiratory Journal

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Worldwide, clinicians face the task of providing millions of patients with the best possible treatment and management of COPD. Currently, management primarily involves short-term 'here-and-now' goals, targeting immediate patient benefit. However, although there is considerable knowledge available to assist clinicians in minimising the current impact of COPD on patients, relatively little is known about which dominant factors predict future risks. These predictors may vary for different outcomes, such as exacerbations, mortality, co-morbidities, and the long-term consequences of COPD. We propose a new paradigm to achieve 'optimal COPD care' based on the concept that here-and-now goals should be integrated with goals to improve long-term outcomes and reduce future risks. Whilst knowledge on risk factors for poorer outcomes in COPD is growing and some data exist on positive effects of pharmacological interventions, information on defining the benefits of all commonly used interventions for reducing the risk of various future disease outcomes is still scarce. Greater insight is needed into the relationships between the two pillars of optimal COPD care: 'best current control' and 'future risk reduction'. This broader approach to disease management should result in improved care for every COPD patient now and into the future.

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“…15,16 Improving patients' ability to use inhalers may help prevent adverse events post-hospital discharge, including hospital readmissions. [17][18][19] Although a handful of randomized trials have demonstrated beneficial effects of hospital-based patient selfmanagement education for asthma, [20][21][22][23] these studies employed multi-faceted, time-intensive interventions that were compared to usual care. While this literature encourages the use of hospital-based education, direction is lacking as to which intervention or component is most effective.…”

Section: Introductionmentioning

confidence: 99%

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

et al. 2012

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BACKGROUND:Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population. OBJECTIVE: To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD. PARTICIPANTS: Hospitalized adults (age 18 years or older) with asthma or COPD. INTERVENTIONS: Participants were randomized to brief intervention [BI]: single-set of verbal and written step-by-step instructions, or, teach-to-goal [TTG]: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back). MAIN MEASURES: The primary outcome was metereddose inhaler (MDI) misuse post-intervention (<75% steps correct). Secondary outcomes included Diskus® misuse, self-reported inhaler technique confidence and prevalence of 30-day health-related events. KEY RESULTS: Of 80 eligible participants, fifty (63%) were enrolled (BI n=26, TTG n=24). While the majority of participants reported being confident with their inhaler technique (MDI 70%, Diskus® 94%), most misused their inhalers pre-intervention (MDI 62%, Diskus® 78%). Post-intervention MDI misuse was significantly lower after TTG vs. BI (12.5 vs. 46%, p= 0.01). The results for Diskus® were similar and approached significance (25 vs. 80%, p=0.05). Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI (1 vs. 8, p=0.02).CONCLUSIONS: TTG appears to be more effective compared with BI. Patients over-estimate their inhaler technique, emphasizing the need for hospital-based interventions to correct inhaler misuse. Although TTG was associated with fewer post-hospitalization healthrelated events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education.

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Effect of Pharmacotherapy on Rate of Decline of Lung Function in Chronic Obstructive Pulmonary Disease

Abstract: Pharmacotherapy with salmeterol plus fluticasone propionate, or the components, reduces the rate of decline of FEV(1) in patients with moderate-to-severe COPD, thus slowing disease progression. Clinical trial (GSK Study Code SCO30003) registered with www.clinicaltrials.gov (NCT00268216).

Cited by 701 publications

References 40 publications

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

A new perspective on optimal care for patients with COPD

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

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