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Vol 77, No 1 (2009)
Published online: 2008-12-19
Submitted: 2013-02-22
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Novel concepts in the pharmacotherapy of chronic obstructive pulmonary disease

Bartolome R. Celli
Pneumonol Alergol Pol 2009;77(1):82-90.

open access

Vol 77, No 1 (2009)
Published online: 2008-12-19
Submitted: 2013-02-22

Abstract

Chronic obstructive pulmonary disease (COPD) is highly prevalent and will continue to be an increasing cause of morbidity and mortality worldwide. COPD is now viewed under a new paradigm as preventable and treatable. In addition, it has become accepted that COPD is not solely a pulmonary disease but also one with important measurable systemic consequences. It follows, that patients diagnosed with COPD have to be comprehensively evaluated to determine the extent of disease so that therapy can be adequately individualized. We now know that smoking cessation, oxygen for hypoxemic patients, lung reduction surgery for selected patients with emphysema, and non-invasive ventilation during severe exacerbations have an impact on mortality. The completion of well planned pharmacological trials have shown the importance of patient centered outcomes and the possible impact on mortality and rate of decline of lung function. This monograph presents an update on the pharmacological therapy of COPD. The future for patients with COPD is bright as primary and secondary prevention of smoking becomes more effective and air quality improves. In addition, current research will unravel the pathogenesis, clinical and phenotypic manifestations of COPD thus providing exciting therapeutic targets. Ultimately, the advent of newer and more effective therapies will lead to a decline in the contribution of this disease to poor world health.

Abstract

Chronic obstructive pulmonary disease (COPD) is highly prevalent and will continue to be an increasing cause of morbidity and mortality worldwide. COPD is now viewed under a new paradigm as preventable and treatable. In addition, it has become accepted that COPD is not solely a pulmonary disease but also one with important measurable systemic consequences. It follows, that patients diagnosed with COPD have to be comprehensively evaluated to determine the extent of disease so that therapy can be adequately individualized. We now know that smoking cessation, oxygen for hypoxemic patients, lung reduction surgery for selected patients with emphysema, and non-invasive ventilation during severe exacerbations have an impact on mortality. The completion of well planned pharmacological trials have shown the importance of patient centered outcomes and the possible impact on mortality and rate of decline of lung function. This monograph presents an update on the pharmacological therapy of COPD. The future for patients with COPD is bright as primary and secondary prevention of smoking becomes more effective and air quality improves. In addition, current research will unravel the pathogenesis, clinical and phenotypic manifestations of COPD thus providing exciting therapeutic targets. Ultimately, the advent of newer and more effective therapies will lead to a decline in the contribution of this disease to poor world health.
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About this article
Title

Novel concepts in the pharmacotherapy of chronic obstructive pulmonary disease

Journal

Advances in Respiratory Medicine

Issue

Vol 77, No 1 (2009)

Pages

82-90

Published online

2008-12-19

Bibliographic record

Pneumonol Alergol Pol 2009;77(1):82-90.

Authors

Bartolome R. Celli

References (85)
  1. Celli BR, MacNee W. ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004; 23(6): 932–946.
  2. Global Obstructive Lung Disease Initiative. www.GOLD.org (2006).
  3. American Thoracic Society. Standards for the diagnosis and case of patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1995; 152: 78–121.
  4. Pauwels RA, Buist AS, Calverley PM, et al. GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001; 163(5): 1256–1276.
  5. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004; 350(10): 1005–1012.
  6. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA. 1994; 272(19): 1497–1505.
  7. Casaburi R, Mahler DA, Jones PW, et al. A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur Respir J. 2002; 19(2): 217–224.
  8. Mahler DA, Donohue JF, Barbee RA, et al. Efficacy of salmeterol xinafoate in the treatment of COPD. Chest. 1999; 115(4): 957–965.
  9. Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med. 1997; 155(4): 1283–1289.
  10. Vincken W, van Noord JA, Greefhorst APM, et al. Dutch/Belgian Tiotropium Study Group. Improved health outcomes in patients with COPD during 1 yr's treatment with tiotropium. Eur Respir J. 2002; 19(2): 209–216.
  11. ZuWallack R, Mahler D, Reilly D, et al. Salmeterol plus theophylline combination therapy in the treatment of COPD. Chest. 2001; 119: 1628–1630.
  12. Burge PS, Calverley PM, Jones PW, et al. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ. 2000; 320(7245): 1297–1303.
  13. Wise R, Connett J, Weinmann G, et al. Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med. 2000; 343(26): 1902–1909.
  14. Hay JG, Stone P, Carter J, et al. Bronchodilator reversibility, exercise performance and breathlessness in stable chronic obstructive pulmonary disease. Eur Respir J. 1992; 5(6): 659–664.
  15. Friedman M, Serby CW, Menjoge SS, et al. Pharmacoeconomic evaluation of a combination of ipratropium plus albuterol compared with ipratropium alone and albuterol alone in COPD. Chest. 1999; 115(3): 635–641.
  16. Belman MJ, Botnick WC, Shin JW. Inhaled bronchodilators reduce dynamic hyperinflation during exercise in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1996; 153(3): 967–975.
  17. O'Donnell DE, Lam M, Webb KA. Spirometric correlates of improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999; 160(2): 542–549.
  18. O'Donnell DE, Voduc N, Fitzpatrick M, et al. Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease. Eur Respir J. 2004; 24(1): 86–94.
  19. O'Donnell DE, Casaburi R, Frith P, et al. 205.440 Investigators. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J. 2004; 23(6): 832–840.
  20. Marin JM, Carrizo SJ, Gascon M, et al. Inspiratory capacity, dynamic hyperinflation, breathlessness, and exercise performance during the 6-minute-walk test in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001; 163(6): 1395–1399.
  21. Martinez FJ, de Oca MM, Whyte RI, et al. Lung-volume reduction improves dyspnea, dynamic hyperinflation, and respiratory muscle function. Am J Respir Crit Care Med. 1997; 155(6): 2018–2023.
  22. Casanova C, Cote C, de Torres JP, et al. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005; 171(6): 591–597.
  23. Agustí A, Noguera A, Sauleda J, et al. Systemic effects of chronic obstructive pulmonary disease. European Respiratory Journal. 2003; 21(2): 347–360.
  24. Nishimura K, Izumi T, Tsukino M, et al. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest. 2002; 121(5): 1434–1440.
  25. Schols AM, Slangen J, Volovics L, et al. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998; 157(6 Pt 1): 1791–1797.
  26. Landbo C, Prescott E, Lange P, et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999; 160(6): 1856–1861.
  27. Gerardi DA, Lovett L, Benoit-Connors ML, et al. Variables related to increased mortality following out-patient pulmonary rehabilitation. Eur Respir J. 1996; 9(3): 431–435.
  28. Pinto-Plata VM, Cote C, Cabral H, et al. The 6-min walk distance: change over time and value as a predictor of survival in severe COPD. Eur Respir J. 2004; 23(1): 28–33.
  29. Cote CG, Dordelly LJ, Celli BR. Impact of COPD exacerbations on patient-centered outcomes. Chest. 2007; 131(3): 696–704.
  30. Imfeld S, Bloch KE, Weder W, et al. The BODE index after lung volume reduction surgery correlates with survival. Chest. 2006; 129(4): 873–878.
  31. Kottke TE, Battista RN, DeFriese GH, et al. Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. JAMA. 1988; 259(19): 2883–2889.
  32. Anderson J, Jorenby D, Scott W, et al. Treating Tobacco Use and Dependence. Chest. 2002; 121(3): 932–941.
  33. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med. 1999; 340(9): 685–691.
  34. Keating GM, Siddiqui MA. Varenicline: a review of its use as an aid to smoking cessation therapy. CNS Drugs. 2006; 20(11): 945–960.
  35. Celli B, ZuWallack R, Wang S, et al. Improvement in resting inspiratory capacity and hyperinflation with tiotropium in COPD patients with increased static lung volumes. Chest. 2003; 124(5): 1743–1748.
  36. O'Donnell DE, Sciurba F, Celli B, et al. Effect of fluticasone propionate/salmeterol on lung hyperinflation and exercise endurance in COPD. Chest. 2006; 130(3): 647–656.
  37. Dahl R, Greefhorst LA, Nowak D, et al. Formoterol in Chronic Obstructive Pulmonary Disease I Study Group. Inhaled formoterol dry powder versus ipratropium bromide in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001; 164(5): 778–784.
  38. Tantucci C, Ellaffi M, Duguet A, et al. Effect of salbutamol on dynamic hyperinflation in chronic obstructive pulmonary disease patients. Eur Respir J. 1998; 12(4): 799–804.
  39. Rennard SI, Anderson W, ZuWallack R, et al. Use of a long-acting inhaled beta2-adrenergic agonist, salmeterol xinafoate, in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001; 163(5): 1087–1092.
  40. Ramirez-Venegas A, Ward J, Lentine T, et al. Salmeterol reduces dyspnea and improves lung function in patients with COPD. Chest. 1997; 112(2): 336–340.
  41. Calverley PMA, Anderson JA, Celli B, et al. TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007; 356(8): 775–789.
  42. Niwehowener D, Rice K, Cote C, et al. Prevention of exacerbations of chronic obstructive pulmonary disease with tiotropium, a once daily anticholinergic: a randomized trial. Ann Intern Med. 2005; 143: 317–326.
  43. van Noord JA, Aumann JL, Janssens E, et al. Comparison of tiotropium once daily, formoterol twice daily and both combined once daily in patients with COPD. Eur Respir J. 2005; 26(2): 214–222.
  44. Decramer M, Celli B, Tashkin DP, et al. Clinical trial design considerations in assessing long-term functional impacts of tiotropium in COPD: the UPLIFT trial. COPD. 2004; 1(2): 303–312.
  45. Celli B, Decramer M, Kesten S, et al. UPLIFT Study Investigators, UPLIFT Study Investigators. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008; 359(15): 1543–1554.
  46. Karpel JP, Kotch A, Zinny M, et al. A comparison of inhaled ipratropium, oral theophylline plus inhaled beta-agonist, and the combination of all three in patients with COPD. Chest. 1994; 105(4): 1089–1094.
  47. Barnes PJ, Ito K, Adcock IM. Corticosteroid resistance in chronic obstructive pulmonary disease: inactivation of histone deacetylase. Lancet. 2004; 363(9410): 731–733.
  48. Rabe KF, Bateman ED, O'Donnell D, et al. Roflumilast--an oral anti-inflammatory treatment for chronic obstructive pulmonary disease: a randomised controlled trial. Lancet. 2005; 366(9485): 563–571.
  49. Rennard SI, Schachter N, Strek M, et al. Cilomilast for COPD: results of a 6-month, placebo-controlled study of a potent, selective inhibitor of phosphodiesterase 4. Chest. 2006; 129(1): 56–66.
  50. Mahler DA, Huang S, Tabrizi M, et al. Efficacy and safety of a monoclonal antibody recognizing interleukin-8 in COPD: a pilot study. Chest. 2004; 126(3): 926–934.
  51. Rennard SI, Fogarty C, Kelsen S, et al. COPD Investigators. The safety and efficacy of infliximab in moderate to severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007; 175(9): 926–934.
  52. Vestbo J. TORCH Study Group. The TORCH (towards a revolution in COPD health) survival study protocol. Eur Respir J. 2004; 24(2): 206–210.
  53. Pauwels RA, Löfdahl CG, Laitinen LA, et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med. 1999; 340(25): 1948–1953.
  54. Vestbo J, Sørensen T, Lange P, et al. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. Lancet. 1999; 353(9167): 1819–1823.
  55. Sin DD, Tu JV. Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001; 164(4): 580–584.
  56. Soriano JB, Vestbo J, Pride NB, et al. Survival in COPD patients after regular use of fluticasone propionate and salmeterol in general practice. Eur Respir J. 2002; 20(4): 819–825.
  57. Calverley PM, Boonsawat W, Cseke Z, et al. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J. 2003; 22(6): 912–919.
  58. Szafranski W, Cukier A, Ramirez A, et al. Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J. 2003; 21(1): 74–81.
  59. Cazzola M, Dahl R. Inhaled combination therapy with long-acting beta 2-agonists and corticosteroids in stable COPD. Chest. 2004; 126(1): 220–237.
  60. Celli BR, Thomas NE, Anderson JA, et al. Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: results from the TORCH study. Am J Respir Crit Care Med. 2008; 178(4): 332–338.
  61. Najafzadeh M, Marra CA, Sadatsafavi M, et al. Canadian Thoracic Society/Canadian Respiratory Clinical Research Consortium. Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2007; 146(8): 545–555.
  62. Petty TL. The National Mucolytic Study. Results of a randomized, double-blind, placebo-controlled study of iodinated glycerol in chronic obstructive bronchitis. Chest. 1990; 97(1): 75–83.
  63. Decramer M, Rutten-van Mölken M, Dekhuijzen PN, et al. Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial. Lancet. 2005; 365(9470): 1552–1560.
  64. Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987; 106(2): 196–204.
  65. Saint S, Bent S, Vittinghoff E, et al. Antibiotics in chronic obstructive pulmonary disease exacerbations. A meta-analysis. JAMA. 1995; 273(12): 957–960.
  66. Stockley RA, O'Brien C, Pye A, et al. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest. 2000; 117(6): 1638–1645.
  67. Miravitlles M. Epidemiology of Chronic Obstructive Pulmonary Disease Exacerbations. Clinical Pulmonary Medicine. 2002; 9(4): 191–197.
  68. Adams SG, Melo J, Luther M, et al. Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD. Chest. 2000; 117(5): 1345–1352.
  69. Dirksen A, Dijkman JH, Madsen F, et al. A randomized clinical trial of alpha(1)-antitrypsin augmentation therapy. Am J Respir Crit Care Med. 1999; 160(5 Pt 1): 1468–1472.
  70. Sandhaus R. Alpha-1-antitrypsin deficiency: new and emerging therapies for alpha-1-antytripsin deficiency. Thorax. 2004; 59: 904–909.
  71. Nichol KL, Baken L, Nelson A. Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease. Ann Intern Med. 1999; 130(5): 397–403.
  72. Nichol KL, Mendelman PM, Mallon KP, et al. Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial. JAMA. 1999; 282(2): 137–144.
  73. Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest. 2000; 117(5 Suppl 2): 398S–401S.
  74. Barnes PJ, Burney PGJ, Silverman EK, et al. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J. 2007; 29(6): 1224–1238.
  75. Davies L, Angus RM, Calverley PM. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet. 1999; 354(9177): 456–460.
  76. Thompson WH, Nielson CP, Carvalho P, et al. Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. Am J Respir Crit Care Med. 1996; 154(2 Pt 1): 407–412.
  77. Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med. 1999; 340(25): 1941–1947.
  78. Nouira S, Marghli S, Belghith M, et al. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial. Lancet. 2001; 358(9298): 2020–2025.
  79. Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998; 157(5 Pt 1): 1418–1422.
  80. Donaldson GC, Seemungal TAR, Bhowmik A, et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002; 57(10): 847–852.
  81. Pinto-Plata VM, Livnat G, Girish M, et al. Systemic cytokines, clinical and physiological changes in patients hospitalized for exacerbation of COPD. Chest. 2007; 131(1): 37–43.
  82. Casanova C, Celli BR, Tost L, et al. Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD. Chest. 2000; 118(6): 1582–1590.
  83. Clini E, Sturani C, Rossi A, et al. The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. European Respiratory Journal. 2002; 20(3): 529–538.
  84. Barnes P, Shapiro S, Pawels R. Chronic obstructive pulmonary disease; molecular and cellular mechanisms. Eur Respir J. 2003; 22: 672–688.
  85. Wouters E, Creutzberg E, Schols A. Systemic effects of COPD. Chest. 2002; 121: 127S–130S.

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