Optimising treatment for COPD--new strategies for combination therapy.

T Welte

doi:10.1111/j.1742-1241.2009.02139.x

Abstract

Chronic obstructive pulmonary disease (COPD) is a multi-component disease characterised by airflow limitation and airway inflammation. Exacerbations of COPD have a considerable impact on the quality of life, daily activities and general well-being of patients and are a great burden on the health system. Thus, the aims of COPD management include not only relieving symptoms and preventing disease progression but also preventing and treating exacerbations. Attention towards the day-to-day burden of the disease is also required in light of evidence that suggests COPD may be variable throughout the day with morning being the time when symptoms are most severe and patients’ ability to perform regular morning activities the most problematic. While available therapies improve clinical symptoms and decrease airway inflammation, they do not unequivocally slow long-term progression or address all disease components. With the burden of COPD continuing to increase, research into new and improved treatment strategies to optimise pharmacotherapy is ongoing – in particular, combination therapies, with a view to their complementary modes of action enabling multiple components of the disease to be addressed. Evidence from recent clinical trials indicates that triple therapy, combining an anticholinergic with an inhaled corticosteroid and a long-acting β2-agonist, may provide clinical benefits additional to those associated with each treatment alone in patients with more severe COPD. This article reviews the evidence for treatment strategies used in COPD with a focus on combination therapies and introduces the 3-month CLIMB study (Evaluation of Efficacy and Safety of Symbicort as an Add-on Treatment to Spiriva in Patients With Severe COPD) which investigated the potential treatment benefits of combining tiotropium with budesonide/formoterol in patients with COPD with regard to lung function, exacerbations, symptoms and morning activities.

Highlights

Chronic obstructive pulmonary disease (COPD) is one of the principal causes of death in most countries and its prevalence is increasing
Evidence from recent clinical trials indicates that triple therapy, combining an anticholinergic with an inhaled corticosteroid and a long-acting b2-agonist, may provide clinical benefits additional to those associated with each treatment alone in patients with more severe COPD
Data from recent clinical trials indicate that triple therapy, combining an anticholinergic with an inhaled corticosteroids (ICSs) and a long-acting b2-agonist (LABA), may provide clinical benefits additional to those associated with each treatment alone in patients with moderate to severe COPD [8,9,10,11]

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is one of the principal causes of death in most countries and its prevalence is increasing. Data from recent clinical trials indicate that triple therapy, combining an anticholinergic with an ICS and a long-acting b2-agonist (LABA), may provide clinical benefits additional to those associated with each treatment alone in patients with moderate to severe COPD [8,9,10,11]. In almost 6000 patients – showed that mean improvements in FEV1 with tiotropium (ranging 87– 103 ml before bronchodilation and 47–65 ml after bronchodilation) were significantly better than placebo at all time points after randomisation (p < 0.001), the differences in mean decline in FEV1 were not statistically significant [8] The authors suggest this finding may be related to the protocol permitting patients to continue using previously prescribed medications other than inhaled anticholinergics, e.g. ICS and LABA, with the high rate of prescriptions for concomitant respiratory medications in both arms of the study (Table 1; 8).

Conclusions

Findings

Funding and Acknowledgement